GOOD AFTERNOON WELCOME
TO THE ASSEMBLY HEARING ON
TELEHEALTH POLICY POST PANDEMIC
ASSEMBLY HEALTH WE'RE GOING TO
GO AHEAD AND CONVENE NOW- DUE
TO THE CONTINUED STAY AT HOME
WATER WE ARE PRACTICING
PHYSICAL DISTANCE SEEN HERE IN
THE HEARING ROOM AND THROUGHOUT
THE CAPITOL BUILDING SO WE'RE
ONLY ABLE TO ACCOMMODATE A
LIMITED NUMBER OF PEOPLE- IN
PROTEST OF PAID IN PERSON.
WE'RE ALSO REQUIRING THE MASS
BE WORN IN PHYSICAL DISTANCE IN
THE MAINTAINED BY ALL MEMBERS
OF THE PUBLIC TESTIFYING
WEATHER HERE IN THE ROOM OR AT
ONE OF OUR VETERAN VIDEO
CONFERENCING SITES YOU DON'T
HAVE A MASK WE CAN PROVIDE ONE
FOR YOU. WHEN FOR THE WITNESS
VIDEO ROOM AND REMOTE TESTIMONY
ST STATION WITNESSES WE REACH
THE PUBLIC COMMENT PORTION OF
THE AGENDA. ACID ANY MEMBERS OF
THE PUBLIC TO TESTIFY WHO WANT
TO TESTIFY. IN THESE ROOMS-
PLEASE MAINTAIN THE SOCIAL
DISTANCING AS YOU MOVE AROUND
THE ROOM. IN ADDITION WE HAVE
PANELISTS AND OTHER MEMBERS OF
THE POLICY. OF THE PUBLIC
MAKING USE OF OUR WITNESS VIDEO
CONFERENCING ROOMS HERE IN THE
CAPITAL. AND A FEW OTHER
LOCATIONS THROUGHOUT THE STATE.
OF THOSE WITNESSES WILL APPEAR
ON THE SCREEN SO MEMBERS CAN
WATCH THEIR TESTIMONY LIVE FROM
OUTSIDE OF THE HEARING ROOM.
ASK QUESTIONS- ALSO SOME
QUESTIONS. ALSO BE USING A
MODERATED TELEPHONE SERVICE TO
WHICH ANY MEMBER THE PUBLIC CAN
PROVIDE COMMENTARY WHEN WE GET
TO THAT POINT IN THE AGENDA.
ANALYSTS HAVE BEEN PROVIDED A-
CALL IN NUMBER PRIOR TO THIS
HEARING- THE CALL IN NUMBER FOR
PUBLIC COMMENT FOR THIS HEARING
IS. EIGHT SEVEN SEVEN. SIX NINE
TWO. EIGHT NINE FIVE SEVEN AND
THE ACCESS CODE IS TWO FOUR
TWO. SIX TWO THREE SEVEN NOW
READ THAT AGAIN. EIGHT SEVEN
SEVEN SIX NINE TWO EIGHT NINE
FIVE SEVEN AND THE ACCESS CODE
IS TWO FOUR TWO SIX TWO THREE
SEVEN. YOU'LL ALSO FIND THIS
NUMBER ON THE ASSEMBLY HEALTH
COMMITTEE'S WEBSITE AS WELL AS
YOUR TLEVISION SCREEN AND THEN
WE GET THE PUBLIC COMMENT I'LL
MENTION IT AGAIN. THE OPERATOR
ON THE LINE WILL GIVE YOU
INSTRUCTIONS ON HOW TO BE
PLACED INTO THE QUEUE. TO
PROVIDE YOU PUBLIC COMMENT IF
YOU ARE CALLING IN- PLEASE
REMEMBER TO ELIMINATE ALL
BACKGROUND NOISE THIS INCLUDES
MUTING YOUR LIVE STREAM
BROADCAST IN YOUR SMART
DEVICES. TO REDUCE THE SOUND
DISTORTION ONCE YOUR PLACE IN
THE QUEUE. YOU ALSO NEED TO
MUTE YOURSELF UNTIL CALLED UPON
TO SPEAK. DO YOU HAVE ANY
PROBLEMS ARE MODERATED TED
PHONE SERVICE YOU CAN CALL THE
COMMITTEE AT NINE ONE SIX THREE
ONE NINE. TWO ZERO NINE SEVEN
AND MY STAFF WILL BE THERE TO
TRY TO HELP I. ALSO WANT TO
KNOW THAT WE ARE ACCEPTING
WRITTEN PUBLIC COMMENT THROUGH
THE HEALTH COMMITTEES PUBLIC
EMAIL WHICH IS A H. E. A. DOT
COMMITTEE. AT ASSEMBLY DOT C.
A. DOT G. O. V. WHICH ALSO CAN
BE FOUND ON OUR WEBSITE- WE MAY
NEED TO LIMIT HOW LONG EACH
PERSON HAS TO PROVIDE PUBLIC
COMMENT. AND WE THANK YOU FOR
YOUR PATIENCE- WAS A THANK YOU
TO ALL OF OUR SPEAKERS FOR
ACCOMMODATING OUR REQUEST TO
PRESENT AT THIS HEARING DURING
THE PANDEMIC. DURING THE PUBLIC
HEALTH EMERGENCY WE'VE ALL
CHANGED HOW WE DO THINGS THIS
INCLUDES HOW HEALTHCARE IS
DELIVERED. HEALTH CARE VIA
VIDEO AND TELEPHONE WAS A MINOR
PART OF THE PRE PANDEMIC MODE
OF HEALTH CARE DELIVERY. WITH
THE NEED FOR SOCIAL DISTANCING
TO PRESERVE. PERSONAL
PROTECTIVE EQUIPMENT- AND
MAINTAIN HEALTH CARE ACCESS
TELEHEALTH USE. HAS JUMPED AS
POLICIES WERE CHANGED TO
ENCOURAGE IT'S USE. TODAY'S
HEARING IS ON WHERE WE GO AFTER
WHAT WE ALL HOPE OCCURS THE
PANDEMIC ENDS. WE CAN GO BACK
TO DOING THINGS IN PERSON
INSTEAD OF JUST OVER SCREENS
AND TELEPHONE LINES. I'D LIKE
TO INVITE ASSEMBLY MEMBER
AGUILAR CURRY'S BEEN A CHAMPION
AND A LEADER AND THE AUTHOR OF
TWO SIGNIFICANT PIECES OF
LEGISLATION ON THIS TOPIC. TO
MAKE OPENING COMMENTS ON DR
ARAMBULA P. LIKE TO MAKE ANY
COMMENTS- ALSO RECOGNIZE OUR
VICE CHAIR AND THEN- ASSEMBLY
MEMBER- RIVAS AS WELL BUT- BUT-
WE ARE WE HAVE- FOUR PANELS TO
DISCUSS THE ISSUE TODAY ALL OF
THEM. ARE USING WEB APPS WEB
WEB APPS WEB ACCESS. SO WE CAN
SEE AND HEAR THEM SPEAK AND
THEIR POWER POINT PRESENTATIONS
AND THE AGENDA- I AND OTHERS
HERE MATERIALS ALSO POSTED ON
THE COMMITTEE WEBSITE UNDER
HEARINGS AND THEN INFO HEARINGS
TAP. SO ASSEMBLY MEMBER
AGUIAR-CURRY GREAT THANK YOU
MISTER CHAIR FOR YOUR OPENING
REMARKS OF HOLDING THIS
INFORMATIONAL HEARING TODAY THE
COVER NINETEEN PANDEMIC HAS
MADE ABUNDANTLY CLEAR WHAT WE
HAVE KNOWN FOR DECADES OUR MOST
VULNERABLE AND MARGINALIZED
COMMUNITIES CONTINUE TO
STRUGGLE FOR AFFORDABLE AND
RELIABLE ACCESS TO HEALTH CARE.
THIS SESSION IN PARTNERSHIP
WITH A BROAD COALITION OF
ADVOCATES AND LEGISLATORS I
INTRODUCED AB THIRTY TWO. A
BILL THAT PROTECTS THE HEALTH
AND WELL BEING OF ALL
CALIFORNIANS PARTICULARLY OUR
MOST VULNERABLE COMMUNITIES BY
SAFEGUARDING EQUITABLE ACCESS
TO HEALTH CARE FOR ALL. AB
THIRTY TWO WILL EXTEND THE
TELEHEALTH FLEXIBILITIES IN
PLACE DURING THE COPA NINETEEN
PANDEMIC. WHICH HAVE BEEN VITAL
TO ENSURING THAT HEALTH CENTERS
CAN CONTINUE PROVIDING SERVICES.
PATIENTS WILL CONTINUETO
EXPECT EXPECT ACCESS TO
TELEHEALTH BECAUSE THEY VALUE
THIS OPTION. ESPECIALLY THOSE
WHO FACE GEOGRAPHIC MOBILITY OR
WORK SCHEDULE BARRIERS TO
ACCESSING HEALTH SERVICES. IT
IS A PARTICULAR PRIORITY OF
MINE TO ADDRESS THE BARRIERS IN
REAL COMMUNITIES IN AREAS FOR
WORKING FAMILIES THROUGHOUT THE
STATE. I BELIEVE THAT WHEN
IMPLEMENTED WELL TELEHEALTH CAN
READ IT REVOLUTIONIZED HOW WE
PROVIDE SAFE AND EFFECTIVE
HEALTH CARE. I ENCOURAGE MY
COLLEAGUES TO JOIN ME IN
CHAMPING THIS IMPORTANT PIECE
OF LEGISLATION WHICH WILL BE
BENEFICIAL TO ALL OF OUR
CONSTITUENTS AND THANK YOU VERY
MUCH DOCTOR WOULD. THANK YOU.
ASSEMBLY MEMBER AGIR CURRY THE
COMMENTS FROM ANYONE'S OKAY
WITH THAT- WE WILL GO AHEAD AND
MOVE ON TO OUR FIRST SPEAKER.
OUR FIRST BAKER IS MEKONG SHE'S
AN ATTORNEY AND THE EXECUTIVE
DIRECTOR OF THE CENTER FOR
CONNECTED HEALTH POLICY. AND
SHE WILL PROVIDE N OVERVIEW TO
OVERVIEW OF TELEHEALTH LAW AND
POLICY IN CALIFORNIA. THANK YOU
CHAIRMAN WOULDN'T THANK YOU TO
THE COMMITTEE FOR HAVING ME
HERE TODAY. I'VE BEEN ASKED TO
REALLY GIVE AN OVERVIEW AND
SORT OF FOUNDATION SETTING FOR
TELEHEALTH AND TELL HOW POLICY
IN CALIFORNIA AND A LITTLE BIT
ON THE FEDERAL LEVEL AS WELL.
NEXT FIVE. IF I HAPPENED TO
MENTION A COMPANYOR YOUR
PRODUCT OF MENTIONED PRODUCTS
JUST WANT TO LET THE COMMITTEE
AT NUMBER YOU KNOW THAT NEITHER
I NOR C. C. H. P. HAS ANY TYPE
OF RELATIONSHIP. WITH SUCH A
COMPANY OR A FINANCIAL
ARRANGEMENT WITH THEM. NEXT
SLIDE. A LITTLE BIT OF
BACKGROUND BUT HE C. H. P. WE
ACTUALLY WERE ESTABLISHED AS A
CALIFORNIA TELL HEALTH POLICY
ORGANIZATION IN TWO THOUSAND
AND NINE AS A PROGRAM
UNDERNEATH THE PUBLIC HEALTH
INSTITUTE. BUT WE APPLIED FOR A
GRANT THROUGH HER SINCE TWO
THOUSAND TWELVE BECOME THE
FEDERALLY DESIGNATED NATIONAL
TELEHEALTH POLICY RESEARCH
CENTER WE'VE BEEN SERVING IN
THAT CAPACITY EVER SENSE. WE
WORK WITH A VARIETY OF OTHER
FUNDERS AND PARTNERS ON THE
STATE AND FEDERAL LEVEL ON
TELEHEALTH PROJECTS. AND PAPERS
AND RESEARCH WE ALSO ACT AS THE
MINISTRY FOR THE NATIONAL
CONSORTIUM TELEHEALTH RESOURCE
CENTER. AND WE ARE COMING HERE
FOR THE CALIFORNIA TELEHEALTH
POLICY COALITION WHICH IS A
COALITION OF OVER ONE HUNDRED
STATEWIDE GROUPS THAT ARE
INTERESTED IN TELEHEALTH POLICY
FOR THE STATE. NEXT SLIDE. AND
NEXT SLIDE. SO I WANTED TO
BEGIN WITH WHAT EXACTLY IS
TELEHEALTH AS THE DEFINITION
DOES VARY FROM JURISDICTION TO
JURISDICTION AND SOMETIMES A
TERM TELEHEALTH AND
TELEMEDICINE ARE USED
INTERCHANGEABLY BASICALLY THE
BASICS OF TELEHEALTH IS THAT IT
IS THE USAGE OF TECHNOLOGY TO
PROVIDE SERVICES WHEN THE
PARTIES ARE IN DIFFERENT
LOCATIONS THAT'S ITS MOST BASIC
DEFINITION THAT'S OUT THERE
EACH JURISDICTION DOES HAVE A
DIFFERENT DEFINITION FOR IT-
BUT THOSE ELEMENTS ARE
BASICALLY THE SAME CALIFORNIA
HAS A FAIRLY BROAD DEFINITION
FOR TELEHEALTH AND THAT WAS
INTENTIONAL WHEN THE DEFINITION
WAS CHANGED BACK IN TWO
THOUSAND AND ELEVEN- THE BROAD
DEFINITION THAT EXIST FOR
TELEHEALTH IN CURRENT.
CALIFORNIA LAW IS TO ENSURE
THAT IT IS ABLE TO DEVELOP AND
GROW WITH HOW TECHNOLOGY
INVOLVES AS WE ALL KNOW
TECHNOLOGY EVOLVES AT A PRETTY
RAPID RATE SO THE UP OPPONENTS
FOR TEL HELP BACK IN TWO
THOUSAND ELEVEN AND THE
LEGISLATURE THAT WANTED TO MAKE
SURE THAT THE LAW THAT WAS
EXISTENCE DEFINITION FOR
TELEHEALTH WAS ABLE TO EXPAND
AND GROW WITH THOSE CHANGES
THAT TAKE PLACE FOR TECHNOLOGY.
NEXT SLIDE. SO THERE ARE
ESSENTIALLY WHEN WE WERE
THINKING OF PRE HELD THAT FOR
MODALITIES TO TELL HEALTH AND I
WOULD BE USING THESE TERMS
THROUGHOUT THE- TESTIMONY AND I
THINK PROBABLY THE OTHER PEOPLE
WHO WOULD TESTIFY WILL BE USING
AS WELL SO IT'S GOOD TO JUST
SORT OF SET THIS TO MAKE SURE
EVERYONE IS FAMILIAR WITH THE
TERMS YOU'RE THINKING MISTER
LIVE VIDEO WHICH IS BASICALLY
WHAT WE'RE DOING NOW TO REAL
TIME INTERACTION. BETWEEN THE
TWO PARTIES WERE IN DIFFERENT
LOCATIONS STOURPORT THAT'S THE
CAPTURE OF INFORMATION AND
SENDING IT TRANSMITTING IT TO
THE SECOND PARTY IT DOES NOT
TAKE PLACE IN REAL TIME SO AN
EXAMPLE IS IF SOMEBODY HAS A
SKIN CONDITION THEY'RE SEEING A
PRIMARY CARE PROVIDER THE
PRIMARY CARE PROVIDER IS NOT
QUITE CERTAIN WHAT EXACTLY THAT
IS THEY TAKE A PICTURE OF IT
AND THEY SEND IT TO A
DERMATOLOGIST WHO WILL EVALUATE
IT AND LOOK AT IT LATER AND
SEND THEIR OWN DIAGNOSIS OR
FURTHER INSTRUCTIONS LATER ON.
BERMEL PATIENT MARK TREES
CONTINUOUS MONITORING OF A
PATIENT'S CONDITION FOR A
PERIOD OF TIME AND THAT CAN
TAKE PLACE IN REAL TIME WE'RE
NOT IN REAL TIME SO A REAL TIME
EXAMPLE IS THINK OF AN ICU UNIT
THE INTENSE OF THIS MAY NOT BE
ON LOCATION AT THAT MOMENT WITH
THE PATIENT BUT THE MARGIN THE
PATIENT FOR A DIFFERENT
LOCATION AND TRANSMITTING
INSTRUCTIONS TO HEALTHCARE
PERSONNEL WHO ARE PHYSICALLY
WITH THE PATIENT THAT'S TAKING
PLACE IN REAL TIME. AND NON
REAL TIME EXAMPLE IS A PATIENT
WHO HAS HYPERTENSION AND THAT
IS BEING MONITORED BY THEIR
HEALTH CARE PROVIDER THE
PATIENT IS TAKING READINGS
LET'S SAY DAILY READINGS AT
HOME AND TRANSMITTING THEM TO
THE HEALTH CARE PROVIDER WHO
AGAIN IS NOT LOOKING AT HIM AS
THEY'RE COMING IN BUT MAYBE
LOOKING AT IT THE END OF THE
WEEK AT THE END THE DAY AT A
LATER TIME. AND IT IS REALLY
JUST THE USAGE OF SOME SORT OF
DEVICE IN ORDER TO PROVIDE SOME
OF THE SERVICES THAT USE ONE OF
THE OTHER MODALITY SO A LAPTOP
OR SMARTPHONE OR IPAD IS
USUALLY WHAT PEOPLE ARE
FAMILIAR WITH THIS USUALLY.
TAKING PLACE OVER APPS. THERE
ANOTHER. THAT IS. THAT INCLUDES
TELEHEALTH TECHNOLOGY BUT IT IS
NOT CONSIDER TELEHEALTH AT
LEAST IN MEDICARE'S AYE IN
CMS'S SIDE. AND THAT'S CALL
COMMUNICATIONS TECHNOLOGY BASED
SERVICES AND I'LL TALK A LITTLE
BIT MORE ABOUT THAT AT BECAUSE
WHEN COVERED HIT. THE CHIU SORT
OF GOT VERY MUDDLED TOGETHER-
BUT IT IS A TERM THAT'S BEEN
COINED BY MEDICARE BUT IT'S
SLOWLY BEEN SEEPING INTO POLICY
BOTH ON THE STATE LEVEL. AND
AMONG COMMERCIAL PAYERS AS WELL
SO NEXT SLIDE. SO MEDICARE
POLICY- IT IS ACTUALLY BEFORE
COBIT NINETEEN IT WAS ONE OF
THE MOST RESTRICTIVE TELL
HEALTH POLICIES IN THE NATION-
IT COMPARED TO A LOT OF STATES
IN THEIR MEDICAID PROGRAMS-
WHAT COMMERCIALS REPAIRS DOING.
MEDICARE I WAS VERY LIMITED IN
WHAT THEY ALLOW TELEHEALTH
SHOULD BE UTILIZED FOR IN PART
OF THAT A BIG PART OF THAT IS
BECAUSE A LOT OF THOSE TELL
HAVE LIMITATIONS. ARE IN
FEDERAL STATUTES SO CMS CAN
ONLY DO SO MUCH IN ORDER TO
ALLOW THE UTILIZATION OF
TELEHEALTH WITHOUT CONGRESS
ACTING. SO WITH THOSE
LIMITATIONS ON THERE A COUPLE
YEARS AGO BACK AROUND
200-015-2000 SIXTEEN REALIZING
THAT THE OTHER MODALITIES THAT
COULD BE UTILIZED BUT- THEY
WERE UNABLE TO ALLOW FOR THEM
TO MEET THE MEDICARE PROGRAM
UNLESS THERE WAS A STATUTORY
CHANGE. CMS CREATED A BUCKET
FOR ANOTHER CHANNEL OF SERVICES
THAT THEY CALL COMMUNICATIONS
TECHNOLOGY BASED SERVICES. NOW
THESE SERVICES WE USE ALL THE
MODALITIES OF TELEHEALTH THAT I
JUST COVERED INCLUDING AUDIO
ONLY FOUND TO DELIVER SERVICES.
BUT THEY ARE NOT CONSIDERED
UNDER MEDICARE'S EYES AS
TELEHEALTH THERE THIS OTHER
CATEGORY OF COMMUNICATIONS
TECHNOLOGY BASED SERVICES
UTILIZE TELEHEALTH
TECHNOLOGIES. BUT THEY ARE NOT
CONSIDER TELEHEALTH AND HOW
MEDICARE HOW CMS ADMINISTERS
THE MEDICARE PROGRAM. WHAT THAT
MEANS THEN IS THERE THEY'RE
ABLE TO COVER THE SERVICES THAT
ARE DELIVERED THROUGH
TELEHEALTH TECHNOLOGIES BUT
BECAUSE IT'S NOT CONSIDER
TELEHEALTH. THEY ARE RESTRICTED
BY WHAT'S IN FEDERAL LAW SO
THEY CAN SET UP THEIR OWN
POLICIES OF WHO CAN RECEIVE THE
SERVICE THIS IS. HOW THE
SERVICES ARE DELIVERED AND WHAT
PROVIDERS PROVIDE THE SERVICES.
NEXT SLIDE. A LOT OF THE POLICY
AROUND TELEHEALTH IS AROUND
REIMBURSEMENT A LOT OF THE
EXISTING SPECIFIC POLICY- OUT
THERE AND THAT'S TRUE FOR BOTH
ON THE FEDERAL STATE LEVEL NOT
ALL POLICY THERE ARE OTHER
THINGS THAT IMPACT TELL HELP
OBVIOUSLY SUGGEST PRESCRIBING
LAWS LICENSING LAWS. BUT A LOT
OF THE ESTABLISHED PARTIALLY IS
AROUND REIMBURSEMENT LIKE GETS
PAID YOU KNOW WHO'S COVERED
WHAT TYPE OF PROVIDED PROVIDE
SERVICES. AND REIMBURSEMENT
POLICY ITSELF IS. BECAUSE
BASICALLY FOUR BASIC ELEMENTS
AND HOW IT'S MADEUP YOU HAVE
THE SERVICE THE LOCATION AMONG
THE ALLEY IN THE PROVIDER SO
FOR EXAMPLE YOU MIGHT SEE A
MEDICAID. POLICY THAT SAYS. THE
MEDICAID PROGRAM WILL COVER OF
MENTAL BEHAVIORAL HEALTH
SERVICES WHEN THE PATIENT IS
LOCATED IN A CLINIC OR A
DOCTOR'S OFFICE WHEN IT'S
DELIVERED VIA LIVE VIDEO AND
IT'S BEING DELIVERED BY A
PSYCHIATRIST. SO THOSE ARE YOUR
SORT OF BASIC ELEMENTS ABOUT
REIMBURSEMENT POLICY AND WHERE
YOU SAW A LOT OF THE POLICY
CHANGES THAT WERE MADE ITS
RESPONSE TO COVER THAT. NEXT
SLIDE. SO WHAT WE HAVE HERE AS
YOU CAN SEE THIS IS A HUNDRED
THOUSAND FOOT LEVEL OVER VIEW
OF WHATPOLICY CHANGES TOOK
PLACE DURING COVERT NINETEEN
AND THE ISSUE AREA IN WHICH
BOTH MEDICARE LOOKED AT AND
MEDICAID PROGRAMS LOOK AT
NATIONALLY. REALLY VERY VERY
SIMILAR TYPE OF MODALITY THE
TYPE LOCATION WHERE PEOPLE ARE
LOCATED ON THE SERVICE TO PLACE
THE TYPE OF PROVIDERS WHO
ALLOWED TO. UTILIZE IT. OTHER
POLICIES THAT IMPACT HOW
TELEHEALTH IS BEING USED
AGAINST SOME OF THE PRESCRIBING
POLICIES WHICH IS UNDERNEATH
THE A AND ALSO PRIVACY AND
SECURITY- PROTECTION SUCH AS
HELPED BY A PRIVACY AND
SECURITY LAWS. SO THERE ARE
CHANGES THAT NEED TO BE ENACTED
IN ALL THESE AREAS BUT THE
MAJORITY OF THE CHANGES RELATED
FOCUSING ON THOSE
REIMBURSEMENT. ISSUES THAT'S
LIFE. SO CALIFORNIA POLICIES SO
IN COMPARISON TO MEDICARE
BEFORE COVERED NINETEEN. MEDI
CAL IS ACTUALLY MUCH MORE
OFFENSE MUCH MORE PROGRESSIVE
AND HOW THEY HANDLE TELEHEALTH
SO MEDICARE HAD VERY STRICT
RESTRICTIONS ON WHERE THE
PATIENT WAS LOCATED THEIR
GEOGRAPHICAL INSIGHT
LIMITATIONS MEDIKAL. DID NOT
HAVE ANY GEOGRAPHICAL
LIMITATIONS AND FOR THE MOST
pLOCATIONS UNLESS YOU'RE TALKING
ABOUT COMMITTEE HEALTH CLINICS
LIKE A FEW AGENCIES. OR RURAL
HEALTH CLINICS. THERE WERE
LIMITATIONS ON THERE BECAUSE OF
HOW THEY'RE STRUCTURED AND SOME
OF THE POLICIES THAT APPLY TO
THEM. THE MODALITY THAT WAS
BEING IS A MEDICARE YOU'RE
ESSENTIALLY LIMITED TO LIVE
VIDEO THERE'S THIS SLIGHT
EXCEPTION FOR THOSE IN HAWAII
AND ALASKA WHERE THEY'RE
ALLOWED TO STORE FOR. FOR MEDIC
HOW THEY ALLOW THE PROVIDER TO
DECIDE WHICH ANALOGY YEARS.
THEY COULD USE EITHER LIVE
VIDEO STORE FOR AND IF IT WAS A
SERVICE THAT WAS PROVIDED BY A
COVERED BY MEDICARE OUT
TYPICALLY IF YOU WHEN YOU
DELIVER THE SERVICE AND PERCENT
AND THERE WAS NO OTHER. FACTOR
THAT WOULD PROHIBIT YOU FROM
USING TECHNOLOGY SUCH AS AN IN
PERSON ALAMAT TO THE SERVICE
THEN THE PROVIDED COULD SELECT
WHICH MODALITY USE FROM LIVE
VIDEO OR STAR FOR. SERVICES
AGAIN AND THERE IS REALLY NOT
LIKE A LIMITATION ON THAT AS
LONG AS IT WAS COVERED IN A
REQUIRE LIKE A PERSON ELEMENT
OR HAD SOME OTHER TYPE OF.
RESTRICTION TO USING
TECHNOLOGY. AND THEN PROVIDERS
AND PROVIDERS WAS A PRETTY
BROAD LESS- THEY ALSO DID
INCLUDE FQHCS IN OUR SEASONING
IN THE MEDICARE PROGRAM AS A
PROVIDER. OF TELEHEALTH THOUGH
THERE THEY DID HAVE SOME
LIMITATIONS SO WHEN COMPARED TO
MEDICARE MEDIC HOW IT WAS
ACTUALLY PRETTY BROAD IT WAS
ACTUALLY ONE OF THE MOST
PROGRESSIVE POLICIES OUT THERE
WHEN YOU COMPARED TO OTHER
STATES. NOW THIS WAS ALL PRE
COVERED NINETEEN AND ACTUALLY
SET CALIFORNIA UP IN A PRETTY
GOOD POSITION WHEN THE PANDEMIC.
CARE ACT. NEXT SLIDE. AND THIS
IS JUST OF A ABYSS FORTY AS YOU
SEE KNOW MEDIC. VERY LIMITED IN
WHAT THEY DO MEDICARE WAS MUCH
MORE EXPANSIVE. I'M THAT JUST
TO GIVE YOU AN IDEA THE
MEDICARE POLICIES ARE REALLY
ABOUT TWO DECADES AGO THEY THE
LAST TIME THERE WAS A MAJOR
UPDATE AND FEDERAL STATUTE TO
THE MEDICARE POLICIES FOR
TELEHEALTH. WAS BACK IN THE
YEAR TWO THOUSAND THERE BEEN
LIKE SMALL UPDATES OVER THE
YEARS BUT THE LAST MAJOR CHANGE
WAS IN TWO THOUSAND. COMPARED
TO MEDICARE OUT WHICH ACTUALLY
UPDATED THEIR TELEHEALTH
POLICIES IN THE SUMMER OF TWO
THOUSAND NINETEEN SO JUST A FEW
MONTHS BEFORE CALVET HECK.
THAT'S LIFE. SO THIS IS JUST AN
OVERVIEW OF WHAT THEY DID
AGAIN- WENT OVER ON THE OTHER
SIDE A COUPLE OTHER THINGS TO
KEEP IN MIND ON WHAT GOES ON
WITH CALIFORNIA TELEHEALTH
POLICY IS THAT THERE ARE. OTHER
REQUIREMENTS SUCH AS A MEANS TO
BE AN ORAL OR WRITTEN CONSENT
THAT IS STATUTORY. ALSO BEFORE
THE PANDEMIC HIT- THIS IS
ASSEMBLY MEMBER AL GORE CURRY'S
BILL AB SEVEN FOUR FOUR JUST
PASSED IN TWO THOUSAND NINETEEN
THAT IMPACTED COMMERCIAL PAIRS.
WHICH REQUIRE COMMERCIAL PAYERS
TO COVER TELEHEALTH DELIVERY
SERVICES THE SAME WAY THEY
WOULD HAVE BEEN PERCENT AND PAY
THE SAME AMOUNT. THOUGH THAT
WOULD NOT KICK IN UNTIL JANUARY
FIRST OF TWENTY TWENTY ONE SO
IT IS IN EFFECT NOW BUT THAT
WAS NOT WHAT WE HAD GOING INTO
THE PANDEMIC. AND THE LICENSURE
CALIFORNIA IS NOT VERY
DIFFERENT FROM A LOT OF OTHER
STATES AND THAT. YOU ARE
REQUIRED TO GET A CALIFORNIA
LICENSE IN ORDER PROVIDE
CALIFORNIA SERVICE START
SERVICES TO CALIFORNIA RESIDENT
OUR CALVET PEOPLE LOCATING
CALIFORNIA. NEXT SLIDE. SO WHAT
WERE THE CHANGES MADE IN
RESPONSE TO KOBE AS I SAID.
HELPER WAS ACTUALLY A PRETTY
GOOD POSITION GOING INTO CALVET
WHETHER TELEHEALTH POLICY BUT
THEY DID NEED TO MAKE SOME
CHANGES IN THE FIRST BIG ONE
WAS AROUND MODALITY. I SAID
THAT THEY WERE. IN THE NEED THE
MEDICARE PROGRAM THEY'RE
ALLOWED TO USE STORE FOR AND
LIVE VIDEO- BUT THE BIG THING
ARE MERGED OF PUFFIN NINETEEN
WAS THE REALIZATION THAT. WHILE
TELEHEALTH COULD. BE AN
EFFECTIVE TOOL A VERY VITAL
TOOL DURING THE PANDEMIC NOT
EVERYBODY HAD ACCESS TO IT FOR
A VARIETY OF REASONS PERHAPS
THEY DIDN'T HAVE BROADBAND
ACCESS TO DIDN'T HAVE EQUIPMENT
OR MAYBE THEY DIDN'T HAVE THE
DIGITAL LITERACY IN ORDER TO
USE. OF THE TELEHEALTH A
PLATFORM IN WHICH YOU KNOW THEY
WERE TRYING TO REACH THE
SERVICES. SO BY ONE OF FEDERAL
AND STATE LEVEL AUDIO ONLY
PHONE WAS ALLOWED AS- OPTION IN
ORDER TO RECEIVE SERVICES AND
THAT WAS AN ADJUSTMENT THAT
MEDICAL HAVE TO MAKE AS WELL.
BASICALLY LIKE EVERYBODY. ELSE
DID. NOT CITE. SERVICE IS NOT
REALLY A LOT THE CALIFORNIA HOW
DID YOU RESPOND TO COVERED
EXCEPT TO EXPAND THEM ALLOW-
SOME OF THE LIMITATIONS. THAT
WERE ON FQHCS AN ARCH USED TO
PROVIDE CERTAIN SERVICES SO.
THAT WAS ONE CHANGE THAT HAD TO
BE DONE NEXT SLIDE. AND THEN
FOR LOCATION AGAIN REALLY NOT
MUCH OF AN ISSUE FOR MEDIC HELP
GENERAL EXCEPT WHEN YOU ARE
TALKING ABOUT THAT WORK ON THAT
HEALTH CENTERS RURAL HEALTH
CLINICS THEY HAD TO HAVE SOME
OF THEIR LIMITATIONS BE LEFT
THAT. PRE COVER NINETEEN THEY
WOULD NOT ALLOW THEM TO PROVIDE
SERVICES WHEN THE PATIENT WAS.
IN THE HOME UNLESS THEY WERE
HOMELESS HOMEBOUND OR MIGRATORY
WORKERS SO THEY WERE VERY
LIMITED IN WHAT SERVICES THEY
COMPRISE OUTSIDE OF LIKE THEIR
CLINIC WALLS. THAT LIMITATION
WAS LIFTED IN RESPONSE TO HELP
THE- NEXT SLIDE. IN THE
PROVIDERS AGAIN NOT REALLY MUCH
THAT CALIFORNIA HAS TO DO SO.
SO CALIFORNIANEXT FLIGHT
CALIFORNIA WAS ACTUALLY IN A
FAIRLY GOOD POSITION AS FAR AS
OUR MEDICAL PROGRAM CONCERNS.
FOR COMMERCIAL PLANS AGAIN THEY
HAD AB SEVEN FOR A PASS BUT IT
HAD NOT BLIND TO THE FACT THAT
SO THERE WAS JUST. YEAR IN
ORDER TO LIKE PUT THAT HAVE
THAT GO INTO A FACT. FAIRLY
BEFORE LIKE JANUARY FIRST
TWENTY TWENTY ONE SO THAT WAS
PUSH THE HAD THE TIME I WAS
PUSH THE HAD A LITTLE BIT. EVEN
THOUGH A LOT OF COMMERCIAL
PAYERS YOU KNOW TO THEIR CREDIT
DID GO FORWARD WITH A LOT OF
TOUGH- TELL HEALTH POLICIES
THEMSELVES AND LIKE WAIVERS IN
ORDER TO ALLOW THEIR-
BENEFICIARIES TO ALSO UTILIZE
TELEHEALTH TO. NEXT SLIDE.
OTHER THAT CROPPED UP DURING
PUBLIC NINETEEN A LOT OF THESE
ARE NOT PARTICULARLY SURPRISING
BROADBAND ISSUE PEOPLE NOT
HAVING CONNECTIVITY- LICENSURE
ISSUE PRIVACY AND SECURITY-
THOSE ARE. ALL ISSUES THAT WERE
BROUGHT UP IN QUESTIONS AND
THEY'VE ALL BEEN ISSUES THAT
REALLY LINGERED AROUND WITH
TELEHEALTH FOR AWHILE SO IF
YOU'VE BEEN IN TELEHEALTH THERE
IF THEY'RE NOT PARTICULARLY
NEW. TO THINK THAT DID ARISE
DURING THE PANDEMIC THAT I
THINK MAY HAVE CAUGHT A FEW
PEOPLE OFF GUARD WACHTLER
OUTDATED FORMS. MECHANISMS YOU
CERTAINLY HAD A LOT OF NEW
PEOPLE USING TELEHEALTH WHO
HADN'T USED IT BEFORE SO
SOMETHING AS SIMPLE AS- I'M NOW
ALLOWED TO BILL FOR TELEHEALTH.
BUT THE FORM THAT I TYPICALLY
USED TO GET REIMBURSEMENT. DOES
NOT HAVE WILL TAKE THOSE
SECTIONS IN WHICH I'M SUPPOSED
TO REPORT THAT I'M USING
TELEHEALTH WHAT DO I DO. SO
THOSE THOSE ARE THINGS THAT
NEEDED TO BE CONSIDERED AS WELL
THAT WAS SOMETHING THAT WE
ENCOUNTERED AS A RESOURCE
CENTER LIKE QUESTION WE WERE
GETTING QUESTIONS FROM PEOPLE
SAYING LIKE. I'M A- I'M A LONG
TERM CARE FACILITY I MATHIS
ORIGINATING SITE I DON'T KNOW
WHAT WE'RE SUPPOSED TO PUT THAT
I'M ACTING AS THAT WHAT DO I
PUT THAT CODE ON THERE SO.
OUTDATED FORMS THE MECHANISMS.
DIDN'T CREATE SOME PROBLEMS FOR
SOME PEOPLE BECAUSE THEY HADN'T
HAD TO USE TELEHEALTH BEFORE SO
THEY DIDN'T HAVE THOSE IN
PLACE. AND THE EDUCATION OF
PROVIDERS AND PATIENTS SO
PROVIDERS THOUGH A LITTLE LESS
OF THE FOR PATIENTS. THIS WAS A
BRAND NEW THING FOR A LOT OF
PATIENTS SO THIS WAS SOMETHING
THAT THEY- ARE NOT USED TO
RECEIVING SERVICES. THROUGH A
MECHANISM THAT THEY WERE
UNFAMILIAR LISTED THERE NEEDS
TO BE THAT OUTREACH AND
EDUCATION TO PATIENTS AND A LOT
OF TIMES ELECTED TO THE
PROVIDERS. WHO A LOT OF THEM
WERE BRAND NEW- TRYING TO START
UP TELEHEALTH PROGRAM SO THEY
WERE JUST TRYING TO LEARN HOW
TO. DO THIS PROPERLY THEMSELVES
BUT THEY'RE ALSO TRYING TO
EDUCATE THEIR PATIENTS TO SO
THAT WAS A BIT OF A STRUGGLE
THAT. I THINK SOME PEOPLE
ENCOUNTERED. AS WELL. THAT'S
LIFE. NOW I DO KNOW THAT THEIR
ARE- PROPOSED. CHANGES HAVE
BEEN BY THEM. AND ALSO DH CS
IT'S COME OUT FOREIGNERS THE H.
YES WE'LL BE TALKING ABOUT THIS
LATER I. I'M NOT GOING TO
REALLY GET DEEPLY INTO IT. BUT
WE HAVE EXAMINED SOME OF THE
PROPOSED CHANGES AND THERE ARE
A COUPLE THINGS THAT I DO WANT
TO HIGHLIGHT THIS. I UNDERSTAND
MAYBE A LITTLE BIT DIFFICULT TO
READ BUT THERE HAVE BEEN SOME
CHANGES THAT IMPACT. THE
POLICIES THAT WE HAD BEFORE
COVERED NINETEENTH ONE OF THE
BIG ONES IS REALLY BASICALLY
MOVING. THE STORY FORWARD
MODALITY OUT OF WHERE IT WAS
WHERE IT WAS AN OPTION FOR.
BOTH PROVIDERS TO USE WHETHER
THE USE LIVE VIDEO STORE FOR IT
AND ALSO ALLOWING ATHLETES CC
IS PART SOME STORE FOR SOME OF
THEIR SERVICES. AND PUTTING IT
INTO ANOTHER. AGAIN LIKE A
BUCKET SIMILAR TO HOW MEDICARE
TREATS TELEHEALTH SOME OF THE
TELL HOPE ABOUT THESE. PUTTING
IT INTO THE OTHER BUCKET OR
THIS OTHER CHANNEL OF SERVICES
OR MODALITIES. IN WHICH- NOT
ONLY WOULD STORE FOR BE LOCATED
BUT ALSO A REMOTE PATIENT
MARCHING THAT'S BEEN PROPOSED
TO BE ADDED. SOMATIC HOW AUDIO
ONLY ANOTHER VIRTUAL
TECHNOLOGIES OF USING LIKE
THESE OTHER MODALITIES THAT
HAVING IT SEPARATED OUT FROM
LIVE VIDEO. LIVE VIDEO WOULD
STILL SAY THAT ESSENTIALY THE
SAME WILL BE OPEN TO LIKE YOU
KNOW DIFFERENT PROVIDERS THAT
WOULD BE OPEN TO LIKE DIFFERENT
LOCATIONS. BUT SOME SHIP OF
MODALITIES INTO THIS OTHER.
AREA WHERE THEY WOULD HAVE
THEIR OWN POLICIES ARE- THE
SCHEDULES BASICALLY THEIR OWN
DIFFERENT WAY OF TREATING THOSE
MODALITIES. AGAIN IT SOUNDS
VERY. SIMILAR AT LEAST IN ON
PAPER LOOKING AT IT AND FROM
WHAT I'VE READ SHE LEFT HOW
MEDICARE'S SORT OF STRUCTURE
THINGS BUT- WHERE MEDICARE DID
THAT BECAUSE THEY WERE. LIMITED
BY WHAT'S IN FEDERAL STATUTE
THIS SEEMS TO BE LIKE A
CONSCIOUS CHOICE TO DO THIS- AS
FAR AS THE PROPOSAL'S ARM. MAY
SO NEXT SLIDE. HOWEVER YOU KNOW
NOT ALL CHANGES FELT LIKE IT
WAS TAKING A STEP BACK. ARE
CHANGING SOME OF LIKE WHAT
EXISTED BEFORE COVER NINETEEN
THERE WERE SOME THINGS THAT.
WERE BEING KEPT AROUND LIKE
WITH THAT. THE TEMPERATURE
CHANGES FOR SOME PROGRAMS WOULD
HAVE MORE FLEXIBILITY TO USE
TELEHEALTH. THE LOCATION
OUTSIDE OF THE CLINIC WALLS FOR
FQHC SISTERS THAT THE HOME BE
ALLOWED TO BE AN ELIGIBLE PLACE
WHERE PATIENTS BE LOCATE
ALLOWING THAT TO HAPPEN SO THAT
WOULD BE STICKING AROUND AS
WELL TO- BUT THERE THERE WERE
SOME SIGNIFICANT SHIFTS FROM
WHAT WE HAD BEFORE COVERED
NINETEEN TWO. IF THESE PROPOSED
CHANGES WERE TO GO INTO EFFECT
AS THEY ARE NOW SO NEXT SLIDE.
AND THIS IS JUST SORT OF A
GRAPHIC OF IT IS THAT THERE ARE
SOME CHANGES THAT BEING ARE
BEING KEPT OVER FROM A PRE
COVER THERE AFTER. SOME OF THE
COVER CHANGES THAT WOULD BE
KEPT AROUND IF THE PROPOSALS GO
FAST AND THEN SOME NEW THINGS
THAT THE PROPOSALS ARE ARE.
OFFERING SUCH AS ADDING REMOTE
PATIENT MONITORING. NEXT SLIDE.
AND I JUST A LITTLE BIT OF A
REAL AT SOME OF THE OTHER
STATES ARE DOING AND FAR AS FAR
AS LIKE WHAT THEY'RE DOING WITH
THEIR TELEHEALTH POLICIES. SO
WE'RE SEEING EXPANSION FROM
WHAT THEY HAD BEFORE SO
MASSACHUSETTS. BEFORE COVER
NINETEEN BASICALLY HAD VERY
LITTLE MEDICAID TELEHEALTH
POLICY SO THEY ARE THEY DID
DEFINITELY EXPANDED. SOME OF
THE OTHER THINGS THAT THEY ARE
DOING THAT LIKE CALIFORNIA AND
I THINK ON THE FEDERAL LEVEL AS
WELL THERE'S- OTHER MEDICAID
PROGRAMS ARE STRUGGLING. TO
DECIDE WHAT TO DO OF AUDIO ONLY
PHONE. SO THEY ARE ARE LOOKING
AT THAT SO FOR EXAMPLE NEW
JERSEY HAS INTRODUCED THE BILL
AT LEAST THAT REQUIRES MEDICAID
PARITY FOR TELEHEALTH INCLUDING
PHONE. WHEN IT'S COMBINED WITH
ASYNCHRONOUS SO THERE ARE SORT
OF DIFFERENT APPROACHES TO HOW
YOU'RE DOING SOME OTHER STATE
MEDICAID PROGRAMS HAVE- ALLOW
FOR AUDIO ONLY PHONE FOR
CERTAIN SERVICES- OR YOU KNOW
MAYBE THERE IS A TIME OF IT IN
FOR LIKE. A COUPLE YEARS-
WATCHING STATE COMMERCIAL
HEALTH PLANS AS WELL AS
MEDICARE MANAGED. CARE PLANS
WOULD REQUIRE REVERSE FOR AUDIO
ONLY FOUND TO BE THE SAME AS
TELEMEDICINE THESE ARE
INTRODUCED BILLS THEY WERE JUST
INTRODUCED IN THE CURRENT
SESSION SO. WE DON'T KNOW IF
THEY WILL SURVIVE THE PROCESS
BUT THOSE ARE A COUPLE THINGS
THAT OTHER STATES ARE DOING.
AND I THINK THAT'S IT I THINK
WE JUST HAVE LIKE A LITTLE BIT.
OF NEXT SLIDE. JUST OTHER. SO
WE DO TRY THE FEDERAL POLICIES
WE TRACKED THE WHAT. STATE IS
GENERAL CALDERON AROUND THEIR
TELEHEALTH POLICIES AND THOSE
ARE JUST SOME LINKS ON OUR
WEBSITE AND I THINK THAT'S IT
AND I'M HAPPY TO TAKE ANY
QUESTIONS THE COMMITTEE MAY
HAVE. WELL THANK YOU VERY MUCH
FOR THE DETAILED OVERVIEW- I'D
LIKE TO SEE. I WILL I DO HAVE A
QUESTION BUT I'D LIKE TO. OPEN
THIS UP TO MY COLLEAGUES TO SEE
IF ANYONE HAS A QUESTION. THEN
THAT IT'S BEST LEFT TO ME SO-
SO. SO IT WOULD HAVE OTHER
STATES DONE IN IN MEDICAID AND
IMPLEMENTING AND- TELEPHONE IN
TELEHEALTH EXPANSION. THE
REASON I ASK IS IT ONE OF THE
ISSUES THAT RUNS THROUGH THE
DISCUSSION AND DEBATE OVER
TELEHEALTH AND TELEPHONE
COVERAGE. IS WHETHER FEE FOR
SERVICE OR CAPITATION OR SOME
ALTERNATE PAYMENT METHOD
METHODOLOGY IS THE WAY TO
AUTHORIZE. COVERAGE FOR THIS
MONTH MODALITIES SO WHAT'S
GOING ON IN OTHER STATES. IF
THERE IS A VERY STRONG FIRST
SECTION TO JURISDICTION SO- TO
START AT THE LIKE THE HIGHEST
LEVEL. YOU ARE GIVEN MEDICAID
PROGRAMS IS ARE GIVEN LIKE A
LOT OF LEEWAY BY CMS AND HOW
THEY DO THEIR TELEHEALTH
POLICIES AND THEY'RE ALSO GIVEN
A LOT OF LEEWAY WITH LIKE HOW
F. TWO H. SEASON ARCH SEES. ARE
REIMBURSED AND WHAT THEY'RE
ALLOWED TO DO WITH THEIR
TELEHEALTH POLICY SO SOME
STATES HAVE. DONE JUST STRAIGHT
PARITY WITH LIKE THEIR PPS
RATE- LEAVE WAS CAUGHT
WISCONSIN WAS THE BLACK LAST
ONE THAT DID IT- OTHER STATES
HAVE DONE CAR BALLOTS. WHERE
THEY HAVE- YOU KNOW. CAR ABOUT
SPECIFIC TOPICS OF SERVICES
THAT A FEW OF THE STATE IS
DOUBLE AT THEIR PPS RATE AND
OTHER SERVICES THAT THEY
PROVIDE. WOULD NOT OTHERS HAVE
LOOKED AT YOU KNOW DIFFERENT
ALTERNATIVE PAYMENT
METHODOLOGIES AND HOW THEY
WOULD REIMBURSE THEM AND OTHERS
HAVE JUST GONE STRAIGHT FOR YOU
WILL GET THE SAME AS A FEE FOR
SERVICE SCHEDULE SO IT'S GOING
TO VARY FROM JURISDICTION TO
JURISDICTION. AND I THINK WE'LL
PROBABLY STILL CONTINUE SEE
SOME OF THAT VARIETY ASK STATE
START TO DECIDE WHAT THEY'RE
GOING TO DO GOING. FOUR FOR
PERMANENT POLICIES BEYOND HOPE
THAT. THREE WELL THANK YOU
THANK YOU VERY MUCH. MUCH
APPRECIATED AND- WITH THAT WILL
GO OUT I GUESS I WAS THE
QUESTION WE HAD SO WILL. YOU
DID A FABULOUS JOB OF AN
OVERVIEW SO THANK YOU THANK YOU
VERY MUCH AND- WE'LL GO AHEAD
TO MOVE ONTO OUR NEXT SPEAKER
THEN SO. OKAY THANK YOU HAVE.
OUR NEXT SPEAKER IS GEARING
CORBETT WHO IS THE EXECUTIVE
DIRECTOR OF THE CALIFORNIA
HEALTH BENEFITS REVIEW PROGRAM
CALMLY NOTICED YOUR BURKE. WHO
WILL SPEAK ON THE CURRENT STATE
OF THE EVIDENCE ON TELEHEALTH
MR CORBETT. GOOD AFTERNOON
DOCTOR WOULD THANK YOU SO MUCH
AND COMMITTEE MEMBERS I HAD A
MOMENTARY GLITCH WHERE MY ZOOM
APP WAS USING MY CAMERA SO
IT'S- IN ABJECT ILLUSTRATION OF
SOME OF THE TECHNICAL
CHALLENGES THAT WE NAVIGATE
WITH TELEHEALTH- THANK YOU SO
MUCH FOR THE OPPORTUNITY TO
SPEAK WITH YOU TODAY. AGAIN MY
NAME IS KAREN CORBETT AND I'M
THE DIRECTOR OF THE CALIFORNIA
HEALTH BENEFITS. REVIEW PROGRAM
I NEXT SLIDE PLEASE. FOUR
MEMBERS OF THE LEGISLATURE IN
OTHERS WHO MAY BE ATTENDING
TODAY'S HEARING WHO MAY BE NEW
TO THE CALIFORNIA HEALTH
BENEFITS REVIEW PROGRAM- A
DENTIST DR WOULD SAID WERE
KNOWN AS CHIPPER- AND WE ARE
HERE TO SUPPORT THE LEGISLATURE
AS AN INDEPENDENT ANALYTIC
RESOURCE- THAT IS HOUSED WITHIN
THE UNIVERSITY OF CALIFORNIA
SYSTEM. WE CONDUCT LEGISLATIVE
ANALYSES ON HEALTH INSURANCE
RELATED LEGISLATION. USING
MULTI DISCIPLINARY FACULTY
DRIVEN TEAMS. ARE CHARGES TO
PROVIDE A NEUTRAL EVIDENCE
BASED ANALYSES AGAIN AT THE
REQUEST OF THE LEGISLATURE. OUR
WORK IS FUNDED THROUGH A SMALL
ASSESSMENT ON HEALTH PLANS AND
FULL INFORMATION ON OUR WORK IN
AUTHORIZING STATUTE MAY BE
FOUND AT. W. W. W. DOT C. H. B.
R. P. DOT ORG. I NEXT SLIDE
PLEASE. SO OUR FIRST ANALYSIS
ON TELEHEALTH WAS BACK IN TWO
THOUSAND FOURTEEN AND THAT
SEEMS LIKE A LONG TIME AGO
THESE DAYS- WE HAVE SUPPORTED
THE LEGISLATURE ON SEVERAL KEY
PIECES OF LEGISLATION IN RECENT
YEARS. WITHOUT THE PREVIOUSLY
MENTIONED AB SEVENTY FOUR FOR
COMMERCIAL PAYMENT PARITY BEING
THE MOST RECENT LEGISLATION
THAT WE ANALYZED WHICH WAS
ENACTED. EARLIER BILLS
ADDRESSED COVERAGE OF TELEPHONE
VISITS AND STATE REGULATED
PLANS AND AS WE HAVE ALL TRUMP
TELEMEDICINE TO TELEHEALTH. SO
DID THE COMPLEXITY AND RANGE OF
MODALITIES EXPANDS. NEXT SLIDE
PLEASE. SO THE TIMELINE OF
BILLS ON THIS TOPIC GOES BACK A
LONG WAYS- THERE'S A TERRIFIC
TYPE IN LINE IN YOUR PACKETS-
SENDER HELEN- THOMPSON WHO WAS
TRAVERSE ORIGINAL BILL
AUTHORED. WAS THE LEAD AUTHOR
ON SB SIXTEEN SIXTY FIVE WAY
BACK IN NINETEEN NINETY SIX IN
TWO THOUSAND AND FIVE ASSEMBLY
MEMBER DAVID KAPIL AND HIS BILL
CHAPTER IN THIS WAS RELATED TO
REIMBURSEMENT. FOR USE OF STORE
AND FORWARD TELEHEALTH BASED I
CARE AND DERMATOLOGY. AB FOUR
FOUR ONE FIVE BY ASSEMBLYMEMBER
DOWNLOAD BACK IN TWO THOUSAND
AND ELEVEN REPLACE THAT
OUTDATED LEGAL TERM OF
TELEMEDICINE WITH TELEHEALTH.
AB PORT FIFTEEN EXPLICITLY
REMOVE LIMITS ON THE LOCATIONS
FOR TELEHEALTH ALLOWING FOR ANY
TYPE OF TELEHEALTH TO BE
COVERED REGARDLESS OF WHERE IT
TAKES PLACE. HOWEVER AB FOR
FIFTEEN ONLY A LOT FOR THE
EXPANDED TYPES OF LOCATION DID
NOT MANDATE THAT IT PAY OR PAY
FOR THOSE SERVICES TAKING PLACE
IN THESE. OTHER TYPES OF
FACILITIES. AB FIFTEEN. THE BAN
ON EMAIL OR TELEPHONE DELIVERED
SERVICES AS WELL. AND THEN WE
HAVE- ASSEMBLY MEMBER CECILIA
AGUILAR CURRY GRANT TO CHAPTER
BILLS IN TWO THOUSAND AND
NINETEEN AS DR. WOULD MENTION
PROVIDING FOR PAYMENT- PARITY.
AB SEVEN FOUR FOUR AND A BE
FOURTEEN NINETY FOUR WHICH
PROVIDED FOR A VARIETY OF
EMERGENCY PROVISIONS DURING AND
FOLLOWING. A STATE OF EMERGENCY
WHICH WAS PRESIDENT NEXT SLIDE
PLEASE. FOR AN EXCELLENT-
COMPILE ATION OF- LEGISLATION-
THE RESOURCE- HERE I THINK IS A
VERY HELPFUL LINKS WE JUST
INCLUDED THAT. AS AN FY I ON
NEXT FLIGHT THANK YOU- SO
YOU'RE BURKE SHE ROLE- THE
COMMITTEE REQUESTED THAT SHE
BURKE TODAY HELP SUPPORT THE
HEARING. BY HELPING TO ANSWER
THEIR QUESTIONS HERE ON THIS
SLIDE BASED ON AN OBJECTIVE
ANALYSIS OF THE AVAILABLE
EVIDENCE WE WERE TASKED WITH
ANSWERING WHETHER HEALTHCARE
SERVICES DELIVERED BY TELEPHONE
TELEHEALTH ARE EQUIVALENT TO IN
PERSON SERVICES. WHETHER THE
USE OF TELEHEALTH SERVICES
AFFECTS THE USE OF OTHER
SERVICES. HOW UTILIZATION OFTEN
TYPE OF TELEHEALTH HAS CHANGED
OVER TIME AND DURING THE COLD
AT NINETEEN PANDEMIC AND
WHETHER PROVIDING TELEHEALTH
SERVICES ARE COST EFFECTIVE.
AND INFORMATION ABOUT EXISTING
DISPARITIES IN ACCESS TO AND
USE OF TELEHEALTH. FINALLY WE
WERE ALSO ASKED TO PROVIDE A
SUMMARYOF THESE FINDINGS IN
THE FORM OF A BRIEF WHICH HAS
BEEN DISTRIBUTED TO EACH OF THE
MEMBERS. NEXT SLIDE PLEASE.
GIBBARD REVIEW THE BEST
AVAILABLE EVIDENCE FROM PEER
REVIEWED AND GREAT LITERATURE
TO ANSWER THESE TWO KEY
QUESTIONS. DOES THE EVIDENCE
INDICATE WHETHER SERVICE IS
DELIVERED VIA TELEHEALTH IN
SPECIFICALLY TELEPHONE. ARE
QUICK ONE TO IN PERSON SERVICES
AND DOES THE EVIDENCE INDICATE
WHETHER THE USE OF TELEHEALTH
SERVICES. AND SPEND
SPECIFICALLY TELEPHONE SERVICES
AFFECT THE USE OF OTHER
SERVICES NEXT SLIDE. WHILE OUR
FULL THAT THE LOGICAL APPROACH
CAN BE FOUND ON OUR WEBSITE I
WANTED TO DRAW YOUR ATTENTION
TO TWO LIMITATIONS OF THE
MEDICAL EVIDENCE WITH RESPECT
TO TELEHEALTH. THE FIRST ISTHE
PACE AT WHICH STUDIES OF
TELEHEALTH ARE PUBLISHED FOR
SIMPLY NOT ABLE TO KEEP PACE
WITH THE RAPID RATE OF CHANGE
IN TELEHEALTH TECHNOLOGY.
VERTICAL IN THE PAST COUPLE
YEARS RIGHT GOOD THINGS ARE
MOVING REALLY FAST. AND THE
SECOND LIMITATION OF THE
STUDIES IS THE INABILITY TO
DISAGGREGATE. THE TELEHEALTH
SERVICES FROM OTHER
INTERVENTIONS SUCH AS
INTEGRATED WEB PORTALS THAT
INCLUDES EMAILS AS WELL AS
PATIENT INFORMATION ABOUT SELF
CARE TEST RESULTS AND THE
ABILITY TO REFILL
PRESCRIPTIONS. NEXT SLIDE
PLEASE. IN ORDER TO DETERMINE
WHETHER TELEHEALTH SERVICES ARE
QUICKLY IN PERSON SERVICES. WE
EXAMINED. HEALTH OUTCOMES
INCLUDING BOTH PHYSIOLOGICAL
MEASURES AND PATIENT REPORTED
OUTCOMES. AND TO PROCESSES OF
CARE OUTCOMES INCLUDING
TREATMENT ADHERENCE ACCURACY OF
DIAGNOSES AND THE ALIGNMENT OF
TREATMENT PLANS WITH CLINICAL
PRACTICE GUIDELINES. JOE BURKE
EXAMINED AFFECTS OF TEL HELP ON
THE USE OF OTHER HEALTH CARE
SERVICES SUCH AS THE WAIT TIME
FOR SPECIALTY CARE OR NUMBER OF
OUTPATIENT VISITS ER VISITS AND
HOSPITALIZATIONS. NEXT SLIDE
PLEASE. OUR MEDICAL
EFFECTIVENESS LITERATURE REVIEW
RETURN ABSTRACTS FOR NEARLY
FOURTEEN HUNDRED ARTICLES SINCE
TWO THOUSAND AND NINETEEN.
REMARKABLY ARE MEDICAL
LIBRARIAN WAS STILL ANSWERING
HIS PHONE AND OUR SMALL TEAM
PRESS SPORT ONCE MANY OF THESE
ARTICLES WERE FILTERED OUT FOR
RELEVANCE JUST SHY OF SIXTY
WERE REVIEWED FOR INCLUSION AND
ARE FREE FOR THE HEARING TODAY.
A TOTAL OF THIRTEEN NEW STUDIES
SINCE TWO THOUSAND AND NINETEEN
BRING COLLUDED THE MEDICAL
EFFECTIVENESS REVIEW FOR THIS
REPORT. I WANT TO CALL OUT YOUR
BIRDS MEDICAL EFFECTIVENESS-
GRADING SYSTEM IN MAKING A CALL
OR A JUDGMENT CALL FOR EACH
OUTCOME MEASURE. TRAVERSE TEAM
USES A GRADING SYSTEM ON THE
ROBUSTNESS OF THE UNDERLYING
STUDIES. FROM RESEARCH DESIGN
STATISTICAL SIGNIFICANCE THE
SIZE OF A FACT AND MORE. OUR
GRADING SYSTEM ALSO CONTAINS AN
OVER ARCHING CONCLUSION THIS
CONCLUSION IS A STATEMENT THAT
CAPTURES THE STRENGTH AND
CONSISTENCY OF THE EVIDENCE ON
THE INTERVENTIONS OF FACT ON AN
OUTCOME. A GRADE OF CLEAR AND
CONVINCING EVIDENCE INDICATES
THAT THERE ARE MULTIPLE STUDIES
OF A TREATMENT AND THAT THE
LARGE MAJORITY OF STUDIES ARE
OF HIGH QUALITY. CONSISTENTLY
FIND THAT THE TREATMENT IS
EITHER AFFECTED OR NOT AFFECTED
CONSIDER THIS THE GOLD GOLD
RATING. UPGRADE OF
PREPONDERANCE OF THE EVIDENCE
INDICATES THAT THE MAJORITY OF
STUDIES REVIEWED ARE CONSISTENT
IN THEIR FINDINGS THAT
TREATMENT IS EITHER AFFECTIVE
OR NOT EFFECTIVE. PERHAPS IN
EASY WAYS TO CONSIDER THAT THE
SILVER SILVER RATING. UPGRADE
OF LIMITED EVIDENCE INDICATES
THAT THE STUDIES HAVE LIMITED
GENERAL'S I GENERALIZE ABILITY
TO THE POPULATION OF INTEREST
AND OR THE STUDIES MAY HAVE HAD
A FATAL FLAW IN RESEARCH DESIGN
OR IMPLEMENTATION CONSIDER
THOSE BRONZE. NOW UPGRADE OF
INCONCLUSIVE EVIDENCE INDICATES
THAT ALTHOUGH SOME STUDIES
INCLUDED IN THE MEDICAL
EFFECTIVENESS REVIEW MIGHT HAVE
FOUND THAT A TREATMENT IS
AFFECTIVE A SIMILAR NUMBER OF
STUDIES OF PEOPLE QUALITY MAY
HAVE SUGGESTED THE OPPOSITE-
THAT THE TREATMENT WAS NOT
EFFECTIVE. AND FINALLY A GRADE
OF INSUFFICIENT EVIDENCE
INDICATES THAT THERE'S IS NOT
ENOUGH EVIDENCE AVAILABLE TO
KNOW WHETHER OR NOT A TREATMENT
IS AFFECTED. EITHER BECAUSE
THERE SIMPLY ARE TOO FEW
STUDIES OF THE TREATMENT OR
BECAUSE THE AVAILABLE STUDIES%
ARE NOT OF HIGH OR ROBUST
QUALITY. I WANT TO POINT OUT IT
DOES NOT NECESSARILY MEAN THAT
A TREATMENT IS NOT EFFECTIVE
IT'S JUST THE EVIDENCE- CANNOT
GIVE US A CALL EITHER WAY. SO
HERE ON THIS SLIDE AS YOU
RECALL VOEPEL COMES WHICH
INCLUDES BOTH PHYSIOLOGICAL
MEASURES AND PATIENT REPORTED
OUTCOMES. IN PROCESS OF CARE
OUTCOMES WHICH INCLUDES
TREATMENT ADHERENCE ACCURACY OF
DIAGNOSES. AND ALIGNMENT OF
TREATMENT PLANTS WITH CLINICAL
PRACTICE GUIDELINES SUCH AS
WAIT TIME FOR SPECIALTY CARE A
NUMBER OF VISITS YOUR VISITS
AND- HOSPITALIZATIONS AND SO
FORTH. YOUR BURKE FOUND THAT
THE EVIDENCE REGARDING WHETHER
TELEHEALTH MODALITIES AND
SERVICES RESULT IN EQUAL OR
BETTER OUTCOMES THAN CARE
DELIVERED IN PERSON IS NOT IS
NOT CONSISTENT ACROSS THE TYPE
OF OUTCOMES THAT HAVE BEEN
STUDYING. SO IN ANSWERING THE
CALL A QUICK WANTS TO IN PERSON
SERVICES QUESTION. SO ON THE
LEFT COLUMN FOR HEALTH OUTCOMES
YOUR BURKE FOUND THE STRENGTH
OF EVIDENCE REGARDING WHETHER
TELEHEALTH RESULTS IN PEOPLE OR
BETTER HEALTH OUTCOMES BURIED
ACROSS TELEHEALTH MODALITIES AS
INDICATED ON THE SLIDE. LIVE
VIDEO CONFERENCING WE FOUND
CLEAR AND CONVINCING EVIDENCE%
THAT TELEPHONE RESULTS IN EQUAL
OR BETTER HEALTH OUTCOMES THEN
CARE DELIVERED IN PERSON. FOR
TELEPHONE WE FOUND A
PREPONDERANCE OF EVIDENCE THAT
TELEPHONE RESULTS IN EQUAL OR
BETTER HEALTH OUTCOMES THEN
CARE DELIVERED IN PERSON. AND
PER EACH CONSOLE WE FOUND
INSUFFICIENT EVIDENCE WHETHER
YOU CONSULT CONSULS RESULTING
EQUAL OR BETTER HEALTH OUTCOMES
THEN CARE DELIVERED IN PERSON.
WE CAN YOU CAN REFER TO CHIP
WORKS FOR BRIEF- PER FULL
CITATIONS AND REFERENCES. NOW
MOVING ON TO PROCESS THESE OF
CARE- WHICH IS AGAIN THE
DELIVERY OF RECOMMENDED CARE
THIS IS IN THE MIDDLE COLUMN.
YOUR BURKE ON THE STRENGTH OF
EVIDENCE REGARDING WHETHER
TELEHEALTH RESULTS IN EQUAL OR
BETTER PROCESS OF CARE OUTCOMES
THIS VARIED ACROSS TELEHEALTH
MODALITIES. AGAIN AS YOU SEE ON
THE SLIDE HARPER LIVE VIDEO
CONFERENCING WE FOUND CLEAR AND
CONVINCING EVIDENCE THAT LIVE
VIDEO RESULTS IN PEOPLE ARE
BETTER PROCESSES OF CARE IN
CARE DELIVERED IN PERSON. BY
TELEPHONE WE FOUND INCONCLUSIVE
EVIDENCE WHETHER TELEPHONE%
RESULTS IN PEOPLE ARE BETTER
PROCESSES OF CARE THEN CARE
DELIVERED IN PERSON. FINALLY
I'LL TURN TO THE FAR RIGHT
COLUMN. THIS IS USE OF OTHER
SERVICES. YOUR BURKE ON THE
STRENGTH OF EVIDENCE REGARDING
WHETHER TELEHEALTH REDUCES THE
USE OF OTHER SERVICES VERY
ACROSS TELEHEALTH MODALITIES.
LIVE VIDEO CONFERENCING WE
FOUND A PREPONDERANCE OF
EVIDENCE THAT LIVE VIDEO DOES
NOT REDUCE USE OF IN PERSON
HEALTHCARE SERVICES COMPARED TO
CARE DELIVERED IN PERSON. FOR
TELEPHONE WE FOUND INCONCLUSIVE
EVIDENCE WHETHER TELEPHONE
AFFECTS THE USE OF OTHER
HEALTHCARE SERVICES COMPARED TO
CARE DELIVERED IN PERSON. AND
FOR EACH CONSOLE WE BOUGHT A
PREPONDERANCE OF EVIDENCE THAT
THE CONSOLE RESULTS IN EQUAL OR
BETTER ACCESS TO CARE AND
UTILIZATION THEN CARE DELIVERED
IN PERSON NEXT SLIDE PLEASE. SO
THIS LIVE SHOWS- UTILIZATION OF
TELEHEALTH SERVICES OVER THE
LAST DECADE WHICH SHOT HAS BEEN
INCREASING I'LL BET SLOWLY.
UTILIZATION OF TELEHEALTH-
HOWEVER THE UTILIZATION OF
TELEHEALTH SERVICES IT
INCREASED SUBSTANTIALLY BETWEEN
FEBRUARY AND APRIL OF TWENTY
TWENTY AS A RESULT OF THE
PANDEMIC AND RELATED SHELTER IN
PLACE ORDERS. THE PANDEMIC
REQUIRED PROVIDERS AND PATIENTS
TO ADAPT EXTRAORDINARILY
QUICKLY ROUTINE CARE LARGELY
STOPPED BEING PROVIDED IN
PERSON TO REDUCE THE CHANCE OF
SPREADING AND CONTRACTING-
CODED NINETEEN. NEXT SLIDE
PLEASE. DURING THE PANDEMIC USE
A TELEPHONE INCREASED
DRAMATICALLY IN MARCH AND APRIL
OF TWENTY TWENTY HOWEVER AS
RESTRICTIONS AROUND TELEHEALTH
TECHNOLOGY LOOSENED VIDEO USE
INCREASED AND OVER TALK
TELEPHONE. TELL HELP USES
HIGHEST AMONG BEHAVIORAL HEALTH
PROVIDERS RADIOLOGIST
PATHOLOGIST EMERGENCY MEDICINE
PHYSICIANS WELL TELL HELP USED
AMONG ALL PROVIDER TYPES
INCREASED DURING THE PANDEMIC
THESE TRENDS HAVE LARGELY HELD.
NEXT SLIDE PLEASE. YOUR BOOKS
UPDATED LITERATURE REVIEW ALSO
FOUND SOME DETAILED COST
ANALYSES BUT ALL OF THESE WERE
LIMITED TO SPECIFIC TELEPHONE
I'M SORRY TELEHEALTH SERVICE
SPECIALTIES GENERALLY
TELEHEALTH WAS ASSOCIATED WITH
OVERALL COST SAVINGS OR WAS
COST NEUTRAL. EXCEPT FOR A
DIRECT TO CONSUMER TELEHEALTH
STUDY WHICH WE DESCRIBED IN OUR
BRIEF. NO RECENT STUDIES WERE
IDENTIFIED THAT FOUND INCREASED
OVERALL COST WITH TELEHEALTH
SERVICES NEXT SLIDE PLEASE.
YOUR BURKE WAS UNABLE TO LOCATE
ANY RECENT ANALYSES THAT
REPORTED DATA ON TELEHOUSE
AFFECTS ON COSTS OVERALL DURING
THE PANDEMIC THE MAJOR CHANGES
IN THE BEHAVIORAL HEALTH
SYSTEMS AND CONSUMERS
ASSOCIATED WITH THE PANDEMIC
MAY HAVE LED TO OVERALL COST
INCREASES RATHER THAN COST
SAVINGS THAT WERE IDENTIFIED.
IN EARLIER STUDIES NEXT SLIDE
PLEASE. NOW TURNING VERY
BRIEFLY TO DISPARITIES AND
SOCIAL DETERMINANTS OF HEALTH.
TELEHEALTH MAY IMPROVE ACCESS
TO HEALTHCARE SERVICES BUT
DISPARITIES IN TELEHEALTH
UTILIZATION PERCENT STE MORE
INFORMATION ON THAT IS
CONTAINED IN OUR BRIEF- IN THE
CONTEXT OF THE CURRENT PANDEMIC
RESEARCHERS HAVE NOTICED THAT
INDIVIDUALS WITH POOR HEALTH.
ARE MOST LIKELY TO BENEFIT FROM
TELEHEALTH SERVICES BUT
PARADOXICALLY THESE INDIVIDUALS
ARE ALSO LESS LIKELY TO USE
TELEHEALTH AND HEALTHIER
INDIVIDUALS. THE DISPARITIES IN
RURAL TELEHEALTH UTILIZATION
MAY BE PARTLY EXPLAINED BY
DISPARITIES IN INFRASTRUCTURE
AND TELL AND TECHNOLOGY ACCESS.
NEXT SLIDE PLEASE. TELEHEALTH
ACCESS AND UTILIZATION VARIES
ACROSS POPULATION GROUPS WITH
NON ENGLISH SPEAKERS PEOPLE OF
COLOR OLDER CALIFORNIANS AND
LOWER INCOME HOUSEHOLDS ALL
REPORTING GREATER TECHNOLOGY
BARRIERS LOWER TELEHEALTH
UTILIZATION AND HIGHER
LIKELIHOOD OF USING TELEPHONE
OR AUDIO ONLY. RATHER THAN
VIDEO TELEHEALTH. TELEHEALTH
DISPARITIES LIKELY PROCESS BUT
MAY HAVE NARROWED AS A RESULT
OF THE KOBE NINETEEN ENDEMIC.
IN BE CUT DUE TO THIS- HEALTH
SYSTEM CHANGES. THERE IS
DISCUSSION OF SOME PROMISING
RESULTS FROM RECENT CALIFORNIA
HEALTH CARE FOUNDATION STUDY IN
OUR BRIEFS. THAT SUGGESTS THAT
INCOME DISPARITIES IN
TELEHEALTH MAY USE MAY BE
DROPPING AND PEOPLE OF COLOR
ARE REPORTING HIGHER USE OF
TELEHEALTH NEXT SLIDE PLEASE.
SO WE'RE IN THE HOMESTRETCH-
LET ME JUST RECAP VERY QUICKLY
BY REMINDING MEMBERS THAT USE
OF TELEHEALTH HAS CHANGED
SUBSTANTIALLY IN THE LAST YEAR
BOTH IN TERMS OF VOLUME AND IN
DELIVERY. AND MORE LITERATURE
EVALUATING THE EFFECTIVENESS IS
FORTHCOMING BUT WE HAVE A LOT
OF EVIDENCE ALREADY AS YOU SEE
IT ALL IN OUR MEDICAL
EFFECTIVENESS FINDINGS.
ALTHOUGH UTILIZATION OF
TELEHEALTH HAS DECREASED FROM
THE PEAK- BACK IN APRIL OF
TWENTY TWENTY. IT IS LIKELY
THAT UTILIZATION OF TELEHEALTH
WILL REMAIN HIGHER THAN PRE
PANDEMIC LEVELS ALTHOUGH THE
MAGNITUDE OF THIS INCREASE IS
REMAINS UNCLEAR. EDDIES OF
TELEHEALTH UP NOT BEEN ABLE TO
KEEP WITH UP WITH A VERY RAPID
RATE OF CHANGE IN TELEHEALTH
TECHNOLOGY AND CHANGES IN USE.
AND THEN THE NEXT AND FINAL
SLIDE. I JUST WRITE BRIEFLY
WOULD LIKE TO THANK IF THERE IS
A TRONG OF TRIP STAFF MARGARET
PICS OF UCSF AND UC DAVIS
JEFFREY ROMAN FROM UCLA.
PROFESSOR JANET COFFMAN OUR
MEDICAL EFFECTIVENESS VICE
CHAIR FROM YOU SEE IF. THANK
YOU VERY MUCH FOR HAVING ME
JOIN YOU TODAY. THANK YOU VERY
MUCH I'D LIKE TO SEE IF THEIR
CONQUESTS GINS FROM MY
COLLEAGUES MISS WALDRON. YEAH
IT JUST REAL QUICK THANK YOU
FOR THE PRESENTATION AND I WAS
JUST WONDERING YOU KNOW SINCE
UTILIZATION OF TELEHEALTH IS
INCREASED- IS THERE A WAY TO
SEE OR COULD WERE YOU ABLE TO
TRACK IF. THERE WAS AN INCREASE
IN EFFICIENCIES IN APPOINTMENT
SETTING FOR PROVIDERS- WHAT I
MEAN BY THAT CAN MORE PEOPLE
ACTUALLY GET INTO A PROVIDER.
WITH TELEHEALTH BECAUSE- YOU
KNOW THAT MAY NOT BE THE DELAYS
THAT MIGHT BE INCURRED WITH IN
PERSON VISITS- DOESN'T SHORTEN
THE TIME. THAT PEOPLE CAN GET
IN FOR AN APPOINTMENT I MEAN I
RECALL OF SEVERAL TIMES TRYING
TO GET INTO A PROVIDER AND WAS
TOLD IT WOULD BE WEEKS MAYBE
EVEN MONTHS BEFORE I COULD GET
IN. HAS THERE BEEN ANY INCREASE
TO ACCESS. IN THAT REGARD. SURE
THANK YOU KNOW THAT'S A THAT'S
A GREAT QUESTION I THINK SOME
OTHER FOLKS WILL PROBABLY BE
ABLE TO SPEAK TO IT BETTER-
BECAUSE THEY ARE- YOU KNOW
WE'RE LOOKING MORE AT THE
IMPACTS OF COVERAGE. BUT
ANECDOTALLY- CERTAINLY I THINK
YOU'RE YOU'RE VERY MUCH ON TO
SOMETHING WHEN IT COMES TO-
THROUGHPUT AND THE CHALLENGES
OF HAVING SAFETY PROTOCOLS AND
CLINIC ENVIRONMENTS. CLEANING
AND SOME OF THE OTHER-
CHALLENGES OF HAVING PROVIDERS
AND STAFF ON SITE AND IT-
CLINIC BASE LOCATIONS ARE
CLINICAL LOCATIONS. SO I THINK
THAT'S VERY MUCH TRUE- FROM A
PANDEMIC- STANDPOINT- AND
THEY'RE PROBABLY OTHER ADDITION
SEES PARTICULARLY WITH NO SHOW
RATES AND- AND SO FORTH. AND
THEN OF COURSE THERE'S THE
ISSUE OF TRANSPORTATION- PEOPLE
HAVING TO TAKE TIME OFF FROM
WORK TO ACCESS CARE AND SO
FORTH SO. YOU'RE A LOT OF AYE
AYE THIN COMPONENTS YOU'RE
QUITE. EXCELLENT QUESTION.
THANK YOU ANY. OKAY HI I HAVE A
QUESTION OKAY SO- PERSONAL
AGAIN THANK YOU VERY MUCH
REALLY APPRECIATE THE
INFORMATION- THE BACKGROUND
BRIEF IDENTIFIES THAT
TELEHEALTH IS USES THE HIGHEST
AMONG BEHAVIORAL HEALTH CARE
PROVIDERS WHICH ISN'T ANY
SURPRISE TO ME- THE OTHER-
PROVIDERS LISTED IN YOUR PRE
FOR RADIOLOGISTS PATHOLOGISTS
ER DOCTORS. BUT NOT PRIMARY
CARE SO DO YOU HAVE ANY
THOUGHTS ON THIS. WELL I THINK
IT IT YOU KNOW IMPART- HE IS AN
ADOPTION STANDPOINT AND A
MINDSET AS AND SO I PROVIDERS
GET USED TO SORT OF SOME OF
THE- PHYSICAL CHARACTERISTICS
OF- YOU KNOW COMPONENTS OF THE
IN PERSON PHYSICAL EXAM. I
THINK THAT IS CHANGING OVER
TIME- AND I THINK SOME OF OUR
OTHER EXPERTS MAY WELL BE ABLE
TO GIVE- AN EXPERT ANSWER ON
THAT EVEN BETTER BUT I THINK
SOME OF THAT IS THE- THE SORT
OF- TRADITIONS OF A PRIMARY
CARE VISIT- AND I THINK. THOSE
IN LARGER- LARGER SYSTEMS- ARE
ADAPTED- AND MOVED TO
TELEHEALTH MORE MORE AS THE
PAST YEAR- EXISTED I THINK
OTHER PROVIDERS WERE ABLE TO
TRANSITION MORE QUICKLY- AND
THERE WERE SOME LOWER
THRESHOLDS TO MAKE THAT LEAP.
OKAY GREAT. SO IN TERMS OF THE
COST OF TELUGU HEALTH AM I
CORRECT THAT- BUT IN YOUR
BACKGROUND THAT THE COST
EFFECTIVE THIS PORTION OF YOUR
BACK ON A BRIEF. DID NOT TAKE
INTO ACCOUNT THE PAYMENT PARITY
REQUIREMENT FOR TELE HEALTH AND
TELE OF. TELEPHONE VISITS AND
MEDICARE. RIGHT SO WHERE WERE
WE WERE BASING THIS OFF OF THE
BROADLY AVAILABLE LITERATURE I
THINK- YOU KNOW THE PROOF WILL
BE IN THE PUTTING IN TERMS OF
DOING SOME RETROSPECTIVE
STUDIES AFTER IN CALIFORNIA IN
THE NEXT YEAR TOO. AND I THINK-
WE WOULD BE ABLE TO GET TO THAT
THAT KEY QUESTIONS SO RIGHT NOW
THE DATA JUST TO SIMPLY DOESN'T
EXISTS AND SO OKA GREAT
CORRECT. WHAT WILL THANK YOU
VERY MUCH MR CORBETT MUCH
APPRECIATED AND- JUST A
COMMENT- JUST I CAN'T SAY HOW
MUCH- THIS COMMITTEE
APPRECIATES YOUR WORK- IN
ANALYZING BILLS THAT THAT COME
BEFORE US AND THE COSTS ON THE
SYSTEM SO. MUCH APPRECIATED
NINE NO- I LOOK FORWARD TO YOUR
REPORTS IN THE IN THE YEAR TO
COME HERE. THANK YOU SO MUCH
THANK YOU SO MUCH OKAY. OKAY
I'M OUR NEXT TWO SPEAKERS ARE
FROM TO THE TOP UNIVERSITIES IN
THE COUNTRY. DR MEHROTRA IS THE
ASSOCIATE DIRECTOR OF HEALTH
CARE POLICY AND MEDICINE AT
HARVARD MEDICAL SCHOOL AND DR
ANAYA IS AN ASSISTANT CLINICAL
PROFESSOR IN THE DEPARTMENT OF
FAMILY MEDICINE AT THE DAVID
GEFFEN GEFFEN SCHOOL OF
MEDICINE AT UCLA THEY BOTH
SPOKEN AND PUBLISHED ON THE
SUBJECT OF TELEHEALTH AND THEY
WILL SPEAK ON- WITH THE POST
PANDEMIC REGULATORY AND PAYMENT
LANDSCAPE SHOULD LOOK LIKE FOR
TELEHEALTH SO WE'LL START WITH
THE DOCTOR- DOCTOR MAROTTA
WHO'S ACTUALLY I ASSUME YOU'RE
OUT EAST AND WHERE IT'S SIX
THIRTY IN THE EVENING. DARK AND
COLD AND MAYBE EVEN SNOWING-
SO- IT'S WARM AND SUNNY HERE IN
CALIFORNIA SO WELCOME TO
CALIFORNIA. THANK YOU DR WAIT
AFTER THAT INTRODUCTION IT IS
COLD AND SNOW HERE IS YOU HAVE
TO RUB IT IN. A BIT THANK YOU
VERY MUCH FOR THAT COMMITTEE
FOR- I PROVIDING ME THIS
OPPORTUNITY TO SPEAK BEFORE
YOU. WHAT I'M HOPING I CAN DO
IN THAT IN MY- ORAL- COMMENTS
HERE IS TO PROVIDE SOUND POLICY
FRAMEWORK HOW DO WE THINK
THROUGH WHAT POST PANDEMIC IN
INTENT REGULATIONS FOR
TELEMEDICINE TO LOOK LIKE- NEXT
LIKE. THE FIRST THING IS WHILE-
BEFORE WE GET INTO THAT I
WANTED TO HIGHLIGHT THAT
THERE'S SOME URGENCY IN
FIGURING THIS OUT. I THINK IT'S
WELL RECOGNIZED THAT
TELEMEDICINE USE HAS
DRAMATICALLY INCREASED DURING
THE PANDEMIC WHAT I THINK IS A
UNDER RECOGNIZED. IS THAT SINCE
THAT PEAK IT HAS FALLEN QUITE
SIGNIFICANTLY- IN THIS IS A
WORK WHERE WE'VE BEEN ANALYZING
WHAT NUMBER THE NUMBER OF
TELEHEALTH VISITS ACROSS FIFTY
THOUSAND PROVIDERS IN THE
UNITED STATES AS A PERCENTAGE
THEIR BASELINE VISITS AND WE
SEE AS- ALL OF YOU KNOW THAT
THERE WAS A HUGE SURGE INTIMATE
APRIL. BUT SINCE THAT POINT
WE'VE SEEN IT DECLINED BY MORE
THAN 50% OUR REASONS FOR THAT.
BUT INCLUDING IN PERTH I
CLINICS REOPENED THROUGHOUT THE
NATION WELL ONE OF THE MAJOR
ONES AND WHY IT'S IMPORTANT
HERE IS THAT CLINICIANS- ARE
UNCERTAIN ABOUT WHAT POST
PANDEMIC PAYMENT POLICIES GONNA
LOOK LIKE. AND IF YOU'RE A BUSY
CLINICIAN WHO JUST GONE THROUGH
A VERY ROUGH TIME FINANCIALLY
WHY WOULD YOU MAKE THAT
INVESTMENT WHEN YOU KNOW THAT
CALM SUMMER TWO THOUSAND TWENTY
ONE. YOU NO LONGER WILL BE
REIMBURSED AND SO THOSE
INVESTMENTS WILL BE FOR NOT.
NEXT SLIDE. I WANT TO EMPHASIZE
THAT I VIEW LIKE SO MUCH IN
POLICY MAKING IT VERY DIFFICULT
BALANCING ACT THAT WE FACE IN
EXPANSIONS OF TELEMEDICINE HOW
DO WE IMPROVE THE ACCESS AND
THE QUALITY OF THE CARE THAT
PATIENTS RECEIVE BUT THERE'S
ALSO THIS RISK OF SPENDING AND
AS I SAID IN SOME OF THE
WRITTEN MATERIALS AND I
CIRCULATED TELEMEDICINE'S
ABILITY TO MAKE THEIR
CONVENIENCE AND MORE ACCESSIBLE
THE KEY TO ITS ENORMOUS
POTENTIAL TO IMPROVE THE HEALTH
OF MANY PATIENTS MAY ALSO BE
ITS ACHILLES HEEL IN TERMS OF.
INCREASED UTILIZATION AND
SPENDING. NEXT SLIDE. IN TERMS
OF A FRAMEWORK I THINK THERE'S
A TO BE A HIGH LEVEL POINTS
THAT I WANT TO START WITH THE
FIRST IS I DON'T THINK WE
SHOULD HAVE A SINGLE
TELEMEDICINE POLICY IF WE WENT
TO A YOU KNOW A CLINICIAN A
HEALTH PLAN POLICY MAKERS A
WHAT'S YOUR DRUG POLICY. YOU
CAN LOOK A LITTLE FUNNY WHAT DO
YOU MEAN THE DRUG POLICY WHICH
DRUG. WHICH PATIENT WHICH
CLINICAL SCENARIO AND I THINK
THAT'S THE SAME LANDS BY WHICH
WE SHOULD BE THINKING ABOUT
TELEMEDICINE THAT THERE IS NO
SINGLE POLICY ACROSS ALL OF
THOSE- PATIENT POPULATIONS AND
CLINICAL CONDITIONS. AND THE
SECOND QUESTION IS THAT OKAY
WHICH AGENTS OR CONDITIONS YOU
RECOVER AND REALLY THINK THAT
SHOULD BE DONE THROUGH THE LENS
OF VALUE. AND VALUE IN THIS
SENSE MEANS HEALTH OUTCOMES
ACHIEVED HER DOLLARS SPEND ARE
WE GETTING. A BETTER BANG FOR
OUR BUCK IN TERMS OF IMPROVING
THE HEALTH OF CALIFORNIANS.
WHAT DOES THAT MEAN WHAT DOES
VALUE MEAN IN THIS CONTEXT OF
TELEMEDICINE IF YOU GO TO THE
NEXT SLIDE. WHAT ARE HIGH VALUE
APPLICATIONS OF TELEMEDICINE.
AND WITH POORLY CONTROLLED
DEPRESSION WHO DOESN'T HAVE
ACCESS TO THE PROVIDER NOW GETS
CARE VIA TELEMEDICINE FOR SAY A
PSYCHIATRIST AND IN THE TACTIC
HIS DEPRESSION IS IMPROVED OR
PERSON WITH POORLY CONTROLLED
DEPRESSION DIABETES WHO NW
GETS TO ACCESS THEIR PRIVATE
WITH THEIR PRIMARY CARE DOCTOR
AND THEIR DIABETES CARE IS
IMPROVED. HOW ABOUT LOW VALUE
UNNECESSARY FOLLOW UP VISITS
YOU KNOW MISS JONES IT IS IT'S
REALLY EASY WHY DON'T YOU JUST
CHECK IN A WEEK OR TWO ONE YOUR
DIABETES THINGS ARE WELL BUT
I'LL JUST MAKE SURE THINGS ARE
OKAY WE'LL JUST CHECK IN VIA
PHONE OR NEXT WEEK WE'LL HAVE
ANOTHER VIDEO VISIT OR PHONE
CALL TO DISCUSS THE LAB TESTS
THAT WERE TODAY OR YOU KNOW
IT'S REALLY I THINK
EVERYTHING'S OKAY BUT WHY DON'T
WE JUST MAKE SURE THAT
EVERYTHING'S OKAY AND I'LL CALL
I'LL CALL AND HAVE A VIDEO
VISIT OR A PHONE CALL WITH MY
DOCTOR TO MAKE SURE THAT I.
IT'S REALLY JUST A COLD. NONE
OF THESE ARE MALICIOUS. ON
EITHER THE PROVIDER OR THE
PATIENT'S SIDE. BUT THE REASON
I HIGHLIGHT THOSE OF THOSE RING
SAMPLES. OF WHERE WE'RE
INCREASING UTILIZATION OF CARE.
OR SPENDING. AND WE'RE NOT
HAVING ANY SUBSTANTIVE BENEFITS
IN TERMS OF HEALTH. AND SO
REALLY WHAT WE WANT TO DO IN
TELEMEDICINE PAYMENT POLICY AND
REGULATIONS IS HOW DO WE
ENCOURAGE THIS HIGHER VALUES.
pNEXT LIKE. SO AGAIN GOING BACK
TO THE IDEA OF WHEN YOU WHEN WE
THINK ABOUT VALUE WE NEED TO BE
THINKING ABOUT WHICH HE SENSE
WHICH CONDITIONS YES IS A
PATIENT WHO LIVES IN A HIGH
INCOME I DON'T KNOW BEVERLY
HILLS AND HAS ACCESS TO
PROVIDERS THE ADDITIONAL VISITS
THEY HERE SHE MIGHT RECEIVE MAY
NOT ADD SUBSTANTIAL HEALTH
WHILE A PATIENT IN A RURAL
COMMUNITY- OR- LOWER INCOME
PATIENTS THOSE ADDITIONAL
VISITS MIGHT BE HIGHER VALUE
BECAUSE OF THE- RESOURCES THEY
ALREADY HAVE. WHICH CONDITION
IS THIS A CONDITION THAT IS
UNDER- WHERE WE ARE WORRIED
ABOUT UNDER USE IN PARTICULAR
CHRONIC ILLNESSES OR WE TALKING
ABOUT CONDITIONS SUCH AS COLDS
RASHES AND OTHERS WHERE THERE
IS A CONCERN ABOUT OVER USE. IS
THE CARE ADDED THERE VERSUS
SUBSTITUTION I HEAR A LOT OF
CONVERSATION ABOUT TELEMEDICINE
CAN REDUCE SPENDING BY. AT
PREVENTING AN EMERGENCY
DEPARTMENT VISIT. OR IS THE
CARE ADDITIVE AND THESE ARE
GONNA REALLY DO. IMPACT WHAT
THE VALUE WORSE COST
IMPLICATIONS ARE OF
TELEMEDICINE. AND THEN LASTLY
ON SOMETHING I'LL COME BACK TO
A LITTLE BIT WHICH IS PAIRED.
IF YOU PAY IF A TELEMEDICINE
VISIT. IS PAID FOR LESS THAN AN
IN PERSON VISIT AND IT WOULD
IMPROVE THE HEALTH SHOULD THE
SAME AMOUNT AND THAT IS GOING
TO BE A HIGHER VALUE
APPLICATION WELL- AND IF YOU
PAY THE SAME AMOUNT THE VALUE
MIGHT BE DECREASED AND THAT'S
SOMETHING. THAT REALLY PLAY
THIS IMPORTANT ROLE WE THINK
ABOUT VALUE. NEXT LIKE. SO
THOSE I HOPE THAT FRAMEWORK
PROVIDES SOME CONTEXT AND
THINKING ABOUT ALL THE
STRATEGIES THAT WE SEE ACROSS
BOTH AT THE FEDERAL LEVEL AND
MEDICARE POLICY IN DIFFERENT
STATES AS WELL AS PRIVATE
INSURERS IN WHICH HOW THEY HAVE
APPLIED TELEMEDICINE POLICY
REALLY IT'S ABOUT MAYBE NOT
ALWAYS SAID EXPLICITLY BUT IT'S
ABOUT HOW DO WE ENCOURAGE HIGH
VALUE AT CARE IN DISCOURAGING
LOW VALUE CARE ALTERNATIVE
PAYMENT MODELS WERE ALREADY
ADDRESSED- THOSE ARE IMPORTANT
IDEA WHICH IS THAT IF WE PAY
PROVIDERS. AND A RISK CONTRACT
AND THEY HAVE TO FACE THE RISK
OF OVER USE THEY'RE GOING TO
EMPHASIZE HIGH VALUE CARE AS
YOU SEE IN SOME OF THE
ACCOUNTABLE CARE ORGANIZATION
CONTRACTS THAT MEDICARE HAS
THEY HAVE GREATER ITS
AVAILABILITY AND USE OF
TELEMEDICINE. IN TERMS OF
BENEFIT DESIGN IN EITHER WE SEE
A LOT NUMBER OF PRIVATE
INSURERS WHO HAVE REINSTATED
OUT OF POCKET COSTS IN THE LAST
MONTH OR TWO FOR TELEMEDICINE
VISITS. OR MEDICARE PREVIOUSLY
WHICH REQUIRED A PERSON TO GO
TO A LOCAL CLINIC. TO HAVE
THEIR TELEMEDICINE VISIT BY
INCREASING THOSE TIME COSTS ARE
OUT OF POCKET COSTS THE THOUGHT
IS THAT YOU'RE ENCOURAGING HIGH
VALUE IN DISCOURAGING LOW VALUE
CARE. WE SEE MANY- PAYERS LIMIT
COVERAGE TO TURN PATIENTS FOR
EXAMPLE RURAL PATIENTS AND
PROVIDERS FOR EXAMPLE PRIMARY
CARE OR CONDITIONS WHERE THE ON
THE MEDICARE SIDE THERE'S
EXPANSIONS OF CARE ONLY. FOR
STROKE CARE A SUBSTANCE USE
DISORDERS AND NOW MOST RECENTLY
BEHAVIORAL HEALTH WITH THE IDEA
THAT THESE ARE PLACES WHERE
THERE'S UNDER USE OF CARE AND
WE'RE GOING TO THE AIRPORT
CHIEF HIGHER VALUE APPLICATIONS
OF TELEMEDICINE. I'VE ALREADY
MENTIONED THE PAYMENT RATE FOR
TELEMEDICINE AND THE IDEA IS
THAT WHEN WE- PAID LESS FOR
TELEMEDICINE WE MIGHT DETER
SOME OF THAT LOWER VALUE CARE.
AND LASTLY THERE HAVE BEEN A
LOT OF CONCERNS ABOUT MANY OF
THE PRIVATE COMPANIES THAT HAVE
EMERGED THAT PROVIDE ONLY
TELEMEDICINE. AND SOME CONCERNS
THAT THEY MIGHT BE PROVIDING
LOWER VALUE CARE THAT'S NOT
REALLY IMPROVING THE HEALTH SO
YOU'LL SEE SOME REGULATIONS
WILL REQUIRE AN IN PERSON VISIT
BEFORE A TELEMEDICINE VISIT
JUST IN THE LAST COUPLE WEEKS
THAT'S WHAT THE CONGRESS. HAS
IMPLEMENTED FOR MEDICARE FOR
BEHAVIORAL HEALTH VISITS. NEXT
TIME. I'D BE REMISS WITHOUT
ADDRESSING A REALLY CRITICAL
ISSUE WHICH IS THE ISSUES OF
DISPARITIES OF CARE AND HOW
THAT APPLIES TELEMEDICINE IN A
PIECE THAT WE PUBLISHED LAST
YEAR- IN THE SUMMER WE LOOKED
ACROSS MEDICARE BENEFICIARIES
IT AT IN THE U. S. THAT'S HOW
WHAT FRACTION OF THOSE MEDICARE
BENEFICIARIES HAD ACCESS TO A
COMPUTER. OR SMARTPHONE THAT
WOULD FACILITATE THE USE OF A
VIDEO MESSAGE. WE FOUND NOT
SURPRISINGLY THAT THOSE- WITH
LESS THAN A 100% OF THE FEDERAL
POVERTY LINE AROUND HALF OF
THEM DID NOT HAVE. A LACK AT
THAT DIGITAL ACCESS. AND AS
INCOME WILL INCREASE THE
DIGITAL AVAILABILITY ADDITIONAL
ACCESS INCREASED. WE THOUGHT
IMPORTANT DIFFERENCES BY RACE
AND ETHNICITY AND WE ALSO SAW
THAT RURAL PATIENTS NOT
SURPRISED BENEFICIARIES NOT
SURPRISINGLY HAD LESS DIGITAL
ACCESS. AND SO THIS IS MADE
SUBSTANTIAL CONCERNS THAT WERE
ALREADY IT NEEDED TO- TODAY
WHICH IS THAT- THAT THE
EXPANSION OF TELEHEALTH BECAUSE
SO MANY OF OUR DISADVANTAGED
POPULATIONS WILL NOT HAVE
THESE- TO BE ABLE TO DO A VIDEO
VISIT. THEREFORE THIS WILL
INCREASE DISPARITIES OF CARE
AND THEN AS DRIVENAS MANY OF
YOU ARE AWARE THE EXPANSION OF
TELEPHONE VISITS- AS ANOTHER
WAY OF PROVIDING CARE DURING
AND THEN. NOW THE FUTURE OF ONE
VISITS ARE REALLY IMPORTANT
BECAUSE AGAIN. THERE'S CERTAIN
PATIENT POPULATIONS THAT WON'T
HAVE ACCESS TO IT. BUT THEN
THERE'S ALSO WHILE TELEPHONE
VISITS ARE RIGHT LIKE THE JUST
FINE FOR MANY CLINICAL
ENCOUNTERS THERE HAS BEEN A
CONCERN THAT IN SOME CLINICAL
ENCOUNTERS A TELEPHONE VISIT IS
NOT SUFFICIENT AND WE NEED THE
VIDEO COMPONENT AND IS THERE A
CONCERN THAT ARE DISADVANTAGED
PATIENTS WITH GAPS- WILL
INABILITY TO HAVE A VIDEO OF
INCIDENTS OF SUBSTANTIAL
CONCERN. NOW NEXT LINE. HOW
THIS ALL PLAYS OUT IS GOING TO
BE SOMETHING THAT'S GOING TO BE
VERY IMPORTANT FOR US TO TRY
JUST LAST WEEK WE PUBLISHED A
PIECE IN A JOURNAL WHERE WE
LOOKED ACROSS WHAT PERCENTAGE
OF ALL THIS IT'S WE'RE
DIFFERENT PATIENT POPULATIONS
THE UNITED STATES RECEIVING
WERE VIA TELEMEDICINE. WE FOUND
CONSISTENT WITH THE CONCERNS-ABOUT THE DIGITAL DIVIDE. THAT
URBAN PATIENTS WERE MUCH MORE
LIKELY TO HAVE A- HIGHER
FRACTION OF THEIR VISITS
PROVIDE TELEMEDICINE. HOWEVER
INTERESTINGLY WHEN WE LOOK AT-
HE PATIENTS BROKEN DOWN BY. THE
THEIR COUNTY AND WHAT FRACTION
OF THE COUNTY WAS WHITE WE
FOUND THAT AS THE POPULATION
BECAME MORE WHITE THE USE OF
TELEMEDICINE REDUCE. AND SO TO
BE VERY IMPORTANT FOR US TO
TRACK. HOW THIS PLAYS OUT
DURING THE PANDEMIC- AS WE MOVE
FORWARD. NEXT SLIDE. SHOULD THE
WRAP UP I WANTED TO PROVIDE MY
OWN RECOMMENDATIONS IN TERMS OF
THINKING ABOUT A POLICY AND
REGULATIONS I THINK THAT- AS
MANY OF US ARE MOVING FOR MANY
ACROSS DIFFERENT APPLICATIONS
BUT WHENEVER WE HAVE
ALTERNATIVE PAYMENT MODELS FOR
CLINICIANS- THAT'S GOING TO
ENCOURAGE HIGHER VALUE USES A
TELEMEDICINE. I DO NOT BELIEVE
THAT WE SHOULD CONTINUE THE
PRODUCTS BANSHA TELEMEDICINE
ACROSS ALL CONDITIONS BUT I
WOULD ADVOCATE FOR MORE LIMITED
EXPANSION TO CERTAIN HIGH VALUE
CONDITIONS SUCH AS BEHAVIORAL
HEALTH SUCH AS SUBSTANCE USE
DISORDERS. AND CHRONIC
ILLNESSES AND ALSO HIGHER RISK
COMMUNITIES IN TERMS OF
PARTICULARLY THOSE WHO ARE
RURAL COMMUNITIES AS WELL AS
THOSE WHO GET CARE FROM SAFETY
NET PROVIDERS. I THINK THE
SAFETY NET PROVIDERS ARE THE
KEY AND THOSE FOR REGULATIONS
THAT WERE ALREADY ELIMINATED I
WOULD MAKE THOSE PERMANENT IN
TERMS OF FOR FEDERALLY
QUALIFIED HEALTH CENTERS AND
RURAL HEALTH CLINICS. I AM
AGAINST THE PAINT THAT PAYMENT
PARITY. AND WE CAN DISCUSS THIS
MORE IN DETAIL LATER BUT I FEEL
THAT WE SHOULD PAY FOR
TELEMEDICINE VISITS BOTH VIDEO
AND AUDIO AT LOWER RATES THAN
IN PERSON VISITS. I AM VERY
CONCERNED ABOUT CREATING A TWO
TIERED SYSTEM IN THE UNITED
STATES- AT EIGHTY AND IN
CALIFORNIA. WHERE FOR PATIENTS
GET TELEPHONE CALLS. AND RICH
PEOPLE GET VIDEO CALLS. THOUGH
I'M VERY COGNISANT THAT ARE
DISADVANTAGED POPULATIONS WON'T
HAVE ACCESS TO VIDEO BUSINESS
RIGHT NOW AND SO WHAT I'M
ADVOCATING FOR IS A LIMITED
EXPANSION FOR TELEPHONE CALLS
IS SUPERIOR TO FACILITATE BOTH
ON THE POLICY SIDE CLINICIAN
SIDE TO EXPAND ACCESS TO VIDEO
ISITS ALL PATIENTS HAVE ACCESS
TO THAT. AND I SHOULD EMPHASIZE
THE ONE NICE THING HERE IS THE
WIND IS AT OUR BACKS THAT THE
ABILITY FOR MORE MORE PATIENTS
TO HAVE ACCESS TO THE VIDEO
VISITS IS INCREASING AS ARE YOU
KNOW SMARTPHONES BECOME MORE
UBIQUITOUS. SO HEY NEXT SLIDE-
SOME OF THE POINTS THAT I'VE
MADE HERE I'M SORRY NO NEXT
LIVE. ARE IN MY WRITTEN
COMMENTS AND I LOOK FORWARD TO
YOUR QUESTIONS. THANK YOU VERY
MUCH REALLY REALLY APPRECIATE
THAT- QUESTIONS FROM MY
COLLEAGUES. I GUESS ON THE
CHATTY ONE TODAY SO I ALWAYS
HAVE CLASS DOESN'T MATTER
DOESN'T MATTER WHAT THE TOPIC
SO- YOU WERE PART OF A WORK
GROUP THAT LOOKED AT WHAT
TELEHEALTH POLICY SHOULD BE IN
VERMONT. SO WHERE DID THEY LAND
ON COVERAGE OF TELEPHONE
TELEPHONE VISITS AND PAIN AT
PARITY. AND SAY MEDICAID AND
PRIVATE COVERAGE. YES I WAS I
TESTIFIED JUST AS I DID HERE-
TALKING I WENT AND SO I
ACTUALLY DO NOT REMEMBER IN
OTHERS- MAKE FONG AND OTHERS
MIGHT REMEMBER EXACTLY HOW-
WHERE THEY CAME DOWN TO ON THAT
MY MEMORY AND I COULD BE WRONG
ON THIS WAS THAT IT WAS NOT
COVERED AT WITH PARITY FOR
TELEPHONE VISITS BUT I COULD BE
WRONG. OKAY I'LL BE HONEST I'M
A LITTLE CONCERNED THAT PAYING
A PARITY WILL GIVE PROVIDERS AN
INCENTIVE TO NOT HAVE PATIENTS
COME INTO THE OFFICE OR TO SET
ASIDE. PART OF THE CURRENT
OFFICE HOURS FOR TELEPHONE AND
TELEHEALTH BILLS. RECALLS SO. I
RECOGNIZE AND APPRECIATE THAT
TELEPHONE CALLS AND VIDEO
VISITS WILL WORK FOR A LOT OF
PATIENCE. MORE IT WON'T WORK
FOR INFANTS. OR SOME ELDERLY
PEOPLE WHO HAVE HEARING LOSS
OR- PEOPLE WITH DEMENTIA- AM I
WRONG TO BE CONCERNED ABOUT
THAT- WHAT ARE YOUR THOUGHTS NO
I THINK THERE'S CERTAINLY MANY
PLACES AND I BELIEVE- MISTER
CORBETT HAS CITED SOME OF OUR
WORK WHERE WE LOOKED AT- THE
USE OF VIDEO CALLS FOR
TREATMENT OF INFANTS FOR-
APPEARED FACTIONS AND WE FOUND
THAT THE QUALITY OF CARE
PROVIDED BY- VIDEO BUSINESS WAS
INFERIOR. WITH A GREATER USE OF
BROAD SPECTRUM ANTIBIOTICS FOR
CHILDREN ARE INFANTSIN THAT
CIRCUMSTANCE. THAT'S JUST A
SAMPLE OF- WHERE TELEMEDICINE
CAN PROVIDE INFERIOR CARE I DO
WANT TO EMPHASIZE THAT'S JUST
ONE CLINICAL AREA THERE MANY
CLINICAL AREAS WHERE AS
DOCUMENTS RECORDED HIGHLIGHTED
WHERE A TELEMEDICINE PROVIDES
EQUAL QUALITY OF CARE BUT SO
BUT A LONG WINDED WAY OF SAYING
I THINK YOUR CONCERN. IS WELL
FOUNDED. WELL AND I THINK I
THINK IN GENERAL SO- I
REPRESENT A VERY RURAL DISTRICT
AND ACCESS TO SOME SPECIALTY
CARE IS PRETTY LIMITED SO. SO
THAT HIGH VALUE CARE THAT MIGHT
BE TO BE ABLE TO BE DELIVERED
THAT MIGHT SAVE A PATIENT- FOR
FIVE HOURS ONE WAY TRIP. COULD
BE A HUGE BENEFIT TO EVERYONE-
AND SO I REALLY CLEARLY SEE THE
VALUE HERE BUT I BUT I DO HAVE
THESE SORT OF LINGERING
QUESTIONS IN THE BACK IN THE
BACK OF MY MIND ABOUT SOME
OTHER OTHER THINGS- INTO TO THE
CONCERNS. EXPRESSED ABOUT HOW
TELEHEALTH IS A CONCERN ABOUT
OVER UTILIZATION YOU TALKED
ABOUT THAT IN YOUR IN YOUR LOW
VALUE THE BILL VALUE VISITS-
POTENTIALLY FRAUD AND I DON'T
LIKE TO BRING A PRODUCT LIKE TO
THINK THAT THAT'S NOT. A
POSSIBILITY BUT- IT'S SOMETHING
I THINK WE OUGHT TO CONSIDER.
SO FOR EXAMPLE WILL TELEPHONE
CALLS THAT OCCUR AS PART OF
ROUTINE CLINICAL PRACTICE NOW
BECOME BILLABLE VISITS- DO WE
HAVE EVIDENCE TO DATE ON EITHER
OF THOSE TWO TOPICS- OKAY YES I
THINK THERE'S A REALLY
IMPORTANT. POINTS THERE- I
THINK THAT WE SHOULD BE
COGNIZANT ALSO ON THE PHONE
CALL SIDE. OF A POTENTIAL
PATIENT BACKLASH AGAIN THIS IS
ANECDOTAL AND I DO RECOGNIZE
THAT. BUT PREVIOUSLY YOU WOULD
CALL MYSELF OR ANOTHER
PHYSICIAN AND SAY YOU KNOW CAN
YOU GIVE ME SOME ADVICE AND I
WOULD GIVE PEOPLE ADVICE. ON
THE TELEPHONE AND I WAS JUST
TIRED OF PART OF WHAT YOU
PROVIDE AS A CLINICIAN. AND NOW
A PATIENT DOES THE SAME AND A
FIVE MINUTE PHONE CALL CENTERS
INTO A VISIT AN AUDIO ONLY.
TELEMEDICINE VISIT. AND THE
PERSON RECEIVES A BILL IN THE
MAIL FOUR HUNDRED AND FORTY
DOLLARS AND IF THEY HAVE A HIGH
DEDUCTIBLE PLAN THAT'S OUT OF
THEIR OWN POCKET. IS YOU DO
HAVE SOME CONCERNS THAT
PATIENTS MAY NOT SEE THE VALUE
I DON'T THINK THAT THAT SHOULD
BE THE GUIDING FORCE BUT I DO
WANT TO RECOGNIZE. THAT THERE
IS THIS ASPECT OF- TELEPHONE
CARE THAT WE NEED TO BE. AT
LEAST COGNIZANT OF. REGARDING
THE FRAUD ISSUE THAT YOU RAISED
THAT IS AN IMPORTANT CONCERN.
AND IT VARIES I THINK BY.
POLICYMAKER HOW MUCH OF THAT IS
AN ISSUE. THE OFFICE OF THE
INSPECTOR GENERAL AND MEDICARE-
PUT PUT OUT A PIECE I THINK
IT'S JUST THE LAST COUPLE DAYS
CALLING THAT. FRAUD IS A MAJOR
ISSUE THEY CALLED OPEN SEASON.
I'VE HEARD FOLKS IN- ON THE
MEDICARE SIDE IN PARTICULAR AND
MET TAX CONCERNED THAT
TELEMEDICINE WILL FACILITATE
FRAUD AND YOU KNOW IT'S- FRAUD
ON STEROIDS. OKAY THAT'S VERY
THESE ARE SOME BOMBASTIC
LANGUAGE THAT FOLKS ARE USING
BUT I DO THINK IT EXPERT THAT
REFLECTS A- I THINK
INAPPROPRIATE CONCERN. THAT
TELEMEDICINE COULD FACILITATE
FRAUD AND IS SOMETHING. THAT
REALLY NEEDS TO BE CAREFULLY
MONITORED. WITH YOU THANK YOU
FOR MUCH- AND- AT THAT THAT'S
PRETTY QUESTION BY- ASSEMBLY
MEMBER AGUIAR-CURRY SO I HAVE A
COUPLE QUESTIONS- WE RING UP
FRAUD. OBVIOUSLY IT'S A OF. THE
RINGS A LOT OF BILLS FOR ALL OF
US. I'M IS A PROFESSIONAL THE
MEDICAL PROFESSIONAL YOU HAVE
ETHICS AND- IT SEEMS TO ME THAT
WHEN YOU'RE GOING THROUGH AND
GETTING YOUR- DEGREE I THINK
pNEED TO FOLLOW BY ONE OF IS
MAKING SURE YOU DON'T HAVE
FRAUD SO. I JUST WAS
QUESTIONING THAT. BUT I'M IN
YOUR STUDIES HAVE YOU DONE
ANYTHING REGARDING- SKILLED-
NURSING FACILITIES OR- HOME
HEALTH CARE OR- I SEE WHERE
THIS COULD WORK WELL IN FROM
OUR SKILLED NURSING FACILITIES
GETTING PEOPLE. TO SEE A DOCTOR
THROUGH A VIDEO CONFERENCE AND
HAVE YOU HAD ANY- INFORMATION
ALONG THAT LINE I'M TRYING TO
BE REALLY BROUGHT ON HOW WE CAN
GET SOME. ACCESS TO HEALTH CARE
TO- ARE SENIOR CITIZENS. YEAH
AT. IDEA A GREAT AREA IN THE
AREA OF SKILLED NURSING
FACILITIES JUST FOR THOSE
UNFAMILIAR IT IS A REALLY
CRITICAL ISSUE OF ACCESS TO
CARE THERE ARE CLINICIANS WHO
COMBINE WEEKLY OR COUPLE EVERY
COUPLE TIMES A WEEK. BUT IN
TERMS OF IN PARTICULAR SOME OF
OUR MOST. OUR SICKEST MEMBERS
OF OUR SOCIETY WHO. RESIDED IN
LONG TERM- SKILLED NURSING
FACILITIES NURSING HOMES THEY
OFTEN LACK THE ACCESS TO
SPECIALTY CARE THEY NEED. AND
IT'S VERY DIFFICULT FROM A
LOGISTICS FINANCING AND
FINANCIAL. SYSTEM TO GET THEM
FROM THE SKILLED NURSING
FACILITY TO- A SPECIALTY A
GERIATRICIAN FOR EXAMPLE OR A
PSYCHIATRIST IN DEPRESSION IS
AN ISSUE. AND I THINK THAT
TELEMEDICINE THAT IS A PATIENT
POPULATION WHERE I. AM
CONCERNED- GREATLY ABOUT UNDER
USE A SPECIALTY CARE AND WOULD
BE A POPULATION THAT I WOULD BE
AT LEAST ADVOCATING FOR
BROADER. GREATER EXPANSION OF
TELEMEDICINE FOR THAT
POPULATION. IN TERMS OF
SPECIFIC STUDIES. THERE A
COUPLE THAT I MIGHT HIGHLIGHT
THE FIRST IS THERE HAVE BEEN
SOME STUDIES INCLUDING A
RANDOMIZED CONTROL TRIAL IN
NURSING HOMES OR SKILLED
NURSING FACILITIES WHERE THEY
HAVE PROVIDED AFTER HOURS
TELEMEDICINE COVERAGE. AND
THERE IS A REALLY HIGH VALUE
APPLICATIONS BECAUSE MANY
PATIENTS IT'S ELEVEN O'CLOCK AT
NIGHT ON A FRIDAY THE NURSES AT
THE NURSING HOME CAN'T GET A
CLINICIAN ON THE PHONE AND
THEY'LL SAY OKAY I'LL JUST
TRANSFER THE PATIENT TO. THE
EMERGENCY DEPARTMENT. THAT'S
OBVIOUSLY VERY DISRUPTIVE FOR
THE PATIENT. AS WELL AS ALSO
QUITE COSTLY TO OUR HEALTHCARE
SYSTEM. AND THAT AFTER HOURS
COVERAGE OF TELEMEDICINE WAS
EFFECTIVE IN BOTH- IMPROVING
THE HEALTH AS WELL AS REDUCING
UTILIZATION IS A REALLY GREAT
EXAMPLE OF HOW TELEMEDICINE CAN
BE USED THEIR- AND THE LAST
POINT I'LL MAKE IS SOME
UNPUBLISHED WORK WE'VE LOOKED
AT THE USE OF TELEMEDICINE. IN
NURSING HOMES AND CONSISTENT
WITH WHAT WE SHOWED YOU
PREVIOUSLY MISSED IN OUT
PATIENT PRACTICES THERE'S BEEN
pA VERY DRAMATIC INCREASE IN THE
USE OF. TELEMEDICINE IN NURSING
HOMES- AT LEAST WHAT WE SEE IN
THE MEDICARE POPULATION. SO WE
HAVE SEEN AND HAD DISCUSSIONS
HERE IN CALIFORNIA REGARDING OF
SKILLED NURSING OR NURSING
HOMES OREGON HEALTH HOME CARE.
AND THE INTEREST IS DEFINITELY
THERE OF COURSE IS ALWAYS THE
COSTS OF THAT RIGHT IS GETTING
THEM THE- ACCESS TO A LAPTOP OR
WHATEVER THE CASE MIGHT BE. OR
AND LACKOF INTERNET
CONNECTIVITY SO THAT'S
SOMETHING I THINK THAT WE COULD
REALLY UTILIZE AND YOU KNOW I
THINK ABOUT THE PANDEMIC AND
HOW MANY PEOPLE WERE IN REST
HOMES OR- ARE NURSING HOMES IN
HIRING SOMEBODY DIDN'T COMBINED
SEEM ON A REGULAR TIME
EVERYBODY GOT A LITTLE
FRIGHTENED TO GO SEE SOME SO. I
THINK DURING THIS TIME IF ANY
THIS WOULD HAVE BEEN A GREAT
TIME THE TELEMEDICINE WAS-
FRONT AND CENTER FOR OUR OUR
SENIOR CITIZENS SO THANK YOU
VERY MUCH. IT'S NO THANK YOU
THANK YOU FOR THE UPDATE BOTH
COMMENTS AND QUESTIONS- SOME
AMERICA ACRE CORRECT I AGREE
YEAH. SO THANK YOU THANK YOU
AGAIN DR MARIA- AND- STAY WARM
OUT THERE. THINGS GET REALLY
APPRECIATE IT OKAY THANK YOU
VERY MUCH- AND NEXT WE'RE GONNA
HEAR FROM DOCTOR AND IDEA.
THANK YOU DR ED THANK YOU TO
ALL FOR HAVING ME- SO HAS A
DOCTOR WOULD MENTION THAT I AM
AN ASSISTANT PROFESSOR IN THE
DEPARTMENT OF FAMILY MEDICINE
AT UCLA- AND I'M INTRODUCED
MYSELF A LITTLE BIT JUST SO YOU
KNOW WHERE I'M COMING FROM- AND
THAT THIS PERSPECTIVE SO. I'M
ON THE COURT FACULTY FOR THE
RESIDENCY PROGRAM I HAVE MY OWN
CONTINUITY CHANNEL AT BOTH OF
OUR CLINICAL SITES ONE IS A
UCLA HEALTH SYSTEM CLINIC HE
AND THE OTHER THE FAMILY
MEDICINE CLINIC WITHIN THAT
COUNTY SYSTEM. I TEACH
RESIDENTS AND MEDICAL STUDENTS
AND I SEE MY OWN PATIENTS AT
BOTHSIDES AND I DO HOSPITAL
MEDICINE AS WELL- I AT WORK
CLOSELY WITH THE LATINO POLICY
AND POLITICS INITIATIVE AND THE
CENTER FOR THE STUDY OF LATINO
HEALTH AND CURRENT CULTURE.
WITH MY PARTNER TO OFFER SOME
OF THE WORK THAT I REFERENCE
TODAY. AND THE LAND THAT I
BRING IS OUT OF A PRIMARY CARE
PHYSICIAN AS WELL AS AN
EDUCATOR AND RESEARCHER IN
THESE VARIOUS CLINICAL
SETTINGS- I THINK THAT PROVIDE
ME WITH WITH BOTH A BIRDS EYE
VIEW AS WELL AS A VIEW FROM THE
TRENCHES. AND SO I PRESENT MY
RECOMMENDATIONS TO YOU FROM
THAT COMPREHENSIVE PERSPECTIVE
AS A PHYSICIAN AND RESEARCHER
WHO CARES FOR THESE POPULATIONS
IN THESE CONTRASTING SETTINGS.
I'M SO MY INTENTION IS TO BRING
YOU MY EXPERTISE AND
PERSPECTIVE REGARDING
TELEHEALTH AND VULNERABLE
POPULATIONS SPECIFICALLY.
INCLUDING LINGUISTICALLY
UNDERSERVED POPULATIONS AND
HELP US TO PROVIDE YOU POLICY
CONSIDERATIONS AND STRATEGIES
TO ENSURE THAT REALLY NO
POPULATION IS. NOT LEFT BEHIND
BACKSIDE. SO IN ORDER TO AVOID
WORSENING HEALTH DISPARITIES
AMONG ALREADY VULNERABLE
POPULATIONS. AS WE ENTER THIS
NEW ERA AND HEALTHCARE DELIVERY
HEALTHEQUITY LANDS MUST BE
APPLIED TO ENVISION WHAT
TELEHEALTH IS GONNA LOOK LIKE.
IN CALIFORNIA'S FUTURE APPLYING
A HEALTH EQUITY LENS MEANS.
REALLY HAD KNOWLEDGE SHARING
THAT POPULATION LEVEL FACTORS.
SUCH AS THE PHYSICAL BUILT
SOCIAL AND POLICY ENVIRONMENT
CAN HAVE A BIGGER IMPACT ON
HEALTH OUTCOMES AN INDIVIDUAL
LEVEL FACTORS AND- THIS IS THE
REASON THAT I'LL BE
RECOMMENDING THINGS LIKE
PAYMENT PARITY AND MY
PRESENTATION TODAY. NEXT LINE.
SO BEFORE HEADING INTO A
DISCUSSION- OF WHAT THE POST
PANDEMIC LANDSCAPE SHOULD LOOK
LIKE I'LL BE DISCUSSING WHAT
OUR CURRENT- TELEHEALTH
ECOSYSTEM IS LIKE BECAUSE I
THINK. BEFORE WE TALK ABOUT OUR
NEXT STEPS IN POLICY RUN
PAYMENT AND THE LIKE WE REALLY
NEED TO FLESH OUT WHAT THINGS
ARE CURRENTLY LIKE FOR THE
SPECIFIC POPULATIONS THAT WERE
HERE ABOUT TODAY- WELL ARGUABLY
INITIALLY NECESSARY GIVEN THE
OVERNIGHT NEED TO ADAPT IN THE
FACE OF THE PANDEMIC. THE
RAPIDLY ACCEPTED MODELS OF
TELEMEDICINE GIVE RISE TO A
VARIETY OF ACCESS BARRIERS FOR
OUR DISADVANTAGED PATIENTS AND
INADVERTENTLY LEAVING SOME OF
OUR MOST VULNERABLE PATIENTS
BEHIND. NEXT LINE. AND AS WE
WERE INVITED HERE TODAY TO AND
FROM THE DISCUSSION AROUND AB
THIRTY TWO AND THAT THE H. YES
TELEHEALTH PROPOSAL START. WITH
THIS DISCUSSION ON THE SPECIFIC
STRUCTURAL INEQUITIES AND THAT
WILL DOUBLE POPULATIONS ARE
FACING IN OUR CURRENT MODEL-
BEST INFORMING POLICY
CONSIDERATIONS AROUND PAYMENT
PARITY AS WELL AS TELEPHONE. OR
AUDIO ONLY ABBAS AT CEMEX SLIDE.
SO TELL HEALTH- THAT IS STILL
HEALTHCARE THAT IS EQUITABLE IS
ACCESSIBLE. BOTH IN PERSON AND
VIRTUALLY FOR ALL INDIVIDUALS
REGARDLESS OF LINGUISTIC
LITERACY OR SOCIOECONOMIC
STATUS IT TAKES INTO ACCOUNT
THE UNDERLYING LANDSCAPE WITHIN
WHICH OUR PATIENTS ARE
SITUATED. AND THE STRUCTURAL
BARRIERS THAT THEY FACE AS A
RESULT- SO FAR AND
UNSURPRISINGLY EXISTING
LITERATURE IS DEMONSTRATING THE
USUAL PATTERNS OF ACCESS
AFFLUENT YOUNG AND NON HISPANIC
WHITE POPULATIONS AND
TELEHEALTH IN RELIEVING BEHIND.
WILL NOBLE AND ALREADY
UNDERSERVED PATIENTS IN THIS IS
A SYSTEM LEVEL FINANCED.
DISPARITIES IN HEALTH CARE
ACCESS OR QUALITY OF CARE FOR
MINORITIES HAVE BEEN
EXTENSIVELY DOCUMENTED IN THE
LITERATURE- PRIOR TO THE
SKYROCKETING AND INCORPORATION
OF TELEHEALTH. YOU KNOW ON
AVERAGE OF LATINOS AND AFRICAN
AMERICANS HAVE WORSE ACCESS TO
EFFECTIVE HEALTH CARE THAN DO
NON HISPANIC WHITES BUT
WORSENING THESE EXISTING
DISPARITIES IF WE SET UP OR
CONTINUE TELEHEALTH ECOSYSTEM
SUCH THAT ONLY ADVANTAGE.
POPULATIONS CAN USE THEM. SO
THE VERY FIRST OF COURSE IS
TECHNOLOGY AND THIS MEANS NOT
ONLY THE PHYSICAL DEVICES- HAVE
BEEN ALLUDED TO BUT ALSO THE
SOFTWARE THAT WE REQUIRE
PATIENTS TO USE IN ORDER TO
ACCESS OUR PORTALS IN OUR
VIRTUAL VISIT. BLACK AND
HISPANIC ADULTS REMAIN
SIGNIFICANTLY LESS LIKELY THAN
WHITES TO OWN A COMPUTER OR TO
HAVE HIGH SPEED INTERNET HOME
82% OF WHITES REPORT OWNING. A
DESKTOP OR LAPTOP COMPUTER
COMPARED 258% OF BLACKS AND 57%
OF HISPANICS SO. IF THE
TELEHEALTH SYSTEMS THAT ARE
EMPLOYED WERE REQUIRE VIRTUAL
VISITS OR PORTAL ACCESS TO
OCCUR VIA A COMPUTER RATHER
THAN A SMARTPHONE FOR EXAMPLE
OR- AND THE USE OF BROADBAND
YOU'RE PHYSICALLY EXCLUDING A
BIG SEGMENT OF THE POPULATION.
ON BEYOND HAVING A PHYSICAL
DEVICE SUCCESSFUL TELEHEALTH
USE REQUIRES THAT PATIENTS HAVE
THE PREREQUISITE EXPERIENCE AND
SKILLS THAT TO USE THAT
REQUIRED SOFTWARE WHICH WE
OFTEN CALL. DIGITAL LITERACY-
AND DESPITE I THINK CREASING
THE USING. ONLINE PORTALS THAT
THEY ARE I TO INCREASE MISSION
I. THERE'S I'VE EVERY ENOUGH MY-
THOSE FOR WHOM ENGLISH IS NOT
THEIR LINK PATIENTS WITH. A
LOWER INCOME LOWER HEALTH
LITERACY ARE SIGNIFICANTLY LESS
LIKELY TO USE PORTALS. BUT
THERE IS DATA DEMONSTRATING
THAT THESE WONDERFUL
POPULATIONS EXPRESSED INTEREST
IN PART ALSO THE ISSUE IS NOT
ONE OF LACK OF INTEREST IT'S
JUST THAT WE'RE NOT DOING IT
RIGHT. ANOTHER BIG ISSUE IS
ACCESS FOR LIMITED ENGLISH
PROFICIENCY POPULATIONS. AND
CALIFORNIA NEARLY 44% OF THE
POPULATION SPEAKS ANOTHER
LANGUAGE OTHER THAN ENGLISH AT
HOME. ABOUT 19% OF THE TOTAL
STATE POPULATION CAN BE
CATEGORIZED AS LIMITED ENGLISH
PROFICIENT. AND AFTER ENGLISH
SPANISH IS THE MOST FREQUENTLY
SPOKEN LANGUAGE IN THE U. S.
BUT THESE OF. ALLEY PEELING AND
LIMITED ENGLISH PROFICIENT
PATIENTS AND THE PHYSICIANS OF
CARE DESIGNED AROUND THE
PROVISION OF CARE FOR ENGLISH
SPEAKING PATIENTS AND- TELL
HEALTH SYSTEMS HAVE BEEN NO
DIFFERENT- THERE'S A RECENT
STUDY OF A HUNDRED AND SEVENTY
HOSPITALS ACROSS THE U. S. AND
ONLY ONE HOSPITAL WEBSITE
CLEARLY NOTED- INTERPRETER
OPTIONS FOR VIRTUAL VISITS AND
MOST HOSPITALS REQUIRE
NAVIGATION IN ENGLISH. FURTHER
MAGNIFYING THIS ISSUE IS THE
VERY LIMITED SUPPLY OF LANGUAGE
CAPABLE PROVIDERS AND IN FACT
OUR PREPARATION RESEARCH SHOWS
THAT SPANISH SPEAKING
PHYSICIANS ARE THE MOST UNDER
REPRESENTED. IN THE PHYSICIAN
WORKFORCE IN CALIFORNIA NEXT
LINE. SO NOT ONLY AND NOT ONLY
HAVE PTIENTS BEEN AFFECTED BY
PATIENT LEVEL STRUCTURAL
BARRIERS BUT ALSO BY- THE
BARRIERS THAT THEIR PROVIDERS
ARE FACING AND THESE ULTIMATELY
AFFECT PATIENTS AND HAVE
AFFECTED DISADVANTAGED PATIENTS
DISPROPORTIONATELY. SO NOT
HAVING THE NEEDED HARDWARE
OFTEN AS SIMPLE AS SAFETY NET
CLINICS NOT HAVING WEBCAMS TO
CONDUCT THEIR VIRTUAL VISITS.
AND THE COST OF IMPLEMENTATION
TO BUILD UP ADEQUATE EQUIPMENT
INFRASTRUCTURE. SYSTEM
INFRASTRUCTURE SO FOR EXAMPLE
ELECTRONIC HEALTH RECORD SYSTEM
CAPACITY LIMITATIONS LIKE THAT
ARE COUNTY FACILITY OUR SYSTEM
DOES NOT SUPPORT LAUNCHING A
VIDEO VISIT FROM THE CHARTER
AND TO THIS DAY WE ARE STILL
WORKING ON PROBABLY SETTING UP
VIDEO VISITS FOR PRIMARY CARE
PATIENTS ARE PATIENTS. DO NOT
HAVE THE OPTION TO ACCESS VIDEO
VISITS. EXISTING CLINIC
CAPACITY SO THIS IS- NOT HAVING
TECH SUPPORT IN MEALS THAT CAN
TROUBLESHOOT DURING ISSUES
LAUNCHING VIRTUAL VISITS WE ARE
ALL FAMILIAR WITH THE ISSUES.
THAT COME UP WITH TECHNOLOGY-
AND MORE SO OF COURSE IN IN
POPULATIONS THAT DON'T HAVE
EXTENSIVE EXPERIENCE-
TROUBLESHOOTING. FIRST THE
CONSULATE BARRIERS IN AB A
STAFF TO. THESE VITAL TASKS-
AND THEN LASTLY PROVIDER
REIMBURSEMENT ISSUES- WHICH I
KNOW YOU'RE AWARE OF IS
CONTRIBUTING TO DISPARITIES IN
ACCESS NAMELY- LACK OF
CONSISTENCY ACROSS BEARS AND
ESPECIALLY HIGHLIGHTED AT THE
ONSET OF THE PANDEMIC LACK OF
PAYMENT PARITY WHICH WE'LL DIVE
INTO- FURTHER IN A BIT BUT-
THESE ISSUES REALLY HIGHLIGHT
SOME AREAS WE. PATIENTS FOR
EXAMPLE BY LIMITING PAYMENT FOR
TELEPHONE VISITS BEFORE
ADDRESSING EQUITABLE ACCESS TO
TECHNOLOGY FOR PATIENTS IN
ALREADY UNDERSERVED COMMUNITIES
ARE ENSURING. EQUITABLE
ALTERNATIVE OPTIONS. MAX LINE.
SO THE PRIMARY CARE PHYSICIAN I
SEE HOW TELEHEALTH TOOLS COULD
SERVE AS AN OPPORTUNITY TO
IMPROVE CHRONIC CARE MANAGEMENT
AND IF DONE RIGHT AND THEY GET
IF DONE RIGHT- IMPROVE HEALTH
DISPARITIES FOR UNDERSERVED
POPULATIONS BY MEETING THOSE
WHO NEED ACCESSIBLE CARE MOST
WHERE THEY ARE- THE GOVERNOR
RECENTLY NOTED IN THE CONTEXT
OF VACCINATION OF FARMWORKERS
THIS IS WHAT I WOULD BE IS
ABOUT MEETING THEM WHERE THEY
ARE. AND WHAT WE'RE SEEING IN
PRACTICE AS WELL AS IN THE
LITERATURE IS THAT THE
CONVENIENCE OF TELEHEALTH CAN
IN FACT LEAD TO REDUCE NO SHOW
RATES BUT THIS IS BECAUSE
PATIENTS ARE ABLE TO RECEIVE
THE CARE THAT THEY ACTUALLY
NEED AND AS A PRIMARY CARE
DOCTOR SO I'LL BE THE FIRST TO
ADMIT IF I GET A NO SHOW IN
THIS LIGHT IS A QUICKLY FILLED
WITH ANOTHER PATIENT. I CAN
BREATHE A SIGH OF RELIEF OF THE
EXTRA TEN MINUTES THAT I GET
BACK LET'S BE HONEST THAT'S
JUST TIME THAT I GET TO SPEND
ON MY IN BOX OF LABS AND EMAILS
FROM PATIENTS BUT YOU KNOW
THAT'S REALLY NOT WHAT'S BEST
FOR PATIENTS DELAYED CARE LEADS
TO HIGHER COSTS LATER. IN THE
FORM OF SPECIALS APPOINTMENTS
ADMISSIONS HOME FOR THE
UNNECESSARY COMPLICATIONS OF
CONDITIONS THAT'LL CONTINUE TO
WORSEN OVER TIME THROUGH WHICH
A PATIENT DELAYS CARE THIS IS
NOT A THEORETICAL RISK THIS IS
WHAT WE SEE DAY IN AND DAY OUT
IN CLINICAL CARE- I'LL
VULNERABLE POPULATIONS YOU CAN
ASK ANYONE OF MY TRAINEES ABOUT
THIS DELAY IN CARE LEADS TO
GREATER PATHOLOGY. MORBIDITY
AND YEARS OF PAYING HEALTHCARE
COSTS IT'S WELL KNOWN THAT
BETTER PATHOLOGY IS SEEN IN THE
SYSTEMS OF CARE IN WHICH
PATIENTS ARE FORCED TO- BY
STRUCTURAL BARRIERS TO DELAY
CARE AND THAT'S SOMETHING EVEN
MY MEDICAL STUDENTS- KNOWING
REFLECT ON SO REDUCING LIMITING
HOW REDUCING SPENDING BY
LIMITING ACCESS MAYBE WORTH
CONSIDERING FOR WELL THE
POPULATIONS WITHOUT EXISTING%
STRUCTURAL AND SYSTEMIC
BARRIERS TO KERR BUT CERTAINLY.
NOT IN THESE POPULATIONS AND
WILL MOST CERTAINLY NOT LEAD TO
REDUCE COSTS IN THE LONG TERM
AND THAT'S A DISTINCT
DISTINCTION THAT I LIKE TO
POINT OUT THESE PATIENTS DON'T
NEED ANY ADDITIONAL. BARRIERS
TO CARE. I KNOW VALUE-
IMPORTANT A HIGHER IS THE WAY
IN WE SEE. SURPASSING THE
AFFECTED OF WHAT A TRADITION.
IN PERSON VISIT MY HAVE I'M
SUCH AS BUYING. IN A RECENT
PAPER THAT WE PUBLISHED LIKE
THE PHYSICIAN BEING ABLE TO DO
A HOME VISIT THE ARBITRAL THERE
OR AND- ALLOWING MORE TIME FOR
COUNSELING AND EDUCATION THAT
YOU MIGHT FIND IN. AN IN PERSON
VISIT AND THIS CAN BE
ESPECIALLY VALUABLE IN THE CARE
OF PATIENTS WITH CHRONIC
DISEASE- AND IS HIGHLIGHTED IN
THE- SUPPORT BRIEF- IN THE
DETAILS OF THE BRIEF AND
STUDIES I FOUND THAT
TELEMEDICINE VISITS EITHER
DECREASE OR DO NOT. INCREASE
FOLLOW UP VISITS. AN INCREASE
TREATMENT ADHERENCE AND SO THAT.
DECREASES COSTS IN THE LONG
TERM. NEXT SIDE. I'M SO WE'LL
LOOK AT FIRST THAT KIND OF THE
LONG TERM- AS LANDSCAPE AND
THEN WE'LL DISCUSS SOME
ADDITIONAL THINGS WE CAN DO IN
THE INTERIM TO GET THEIR- SIDE.
SO A SOLUTION THAT'S GONNA SET
US UP TO ACHIEVE GOOD
INEQUITABLE OUTCOMES WHILE
USING HEALTHCARE RESOURCES
WISELY- IS INTEGRATED
TELEHEALTH AS FOR EXAMPLE IT'S
KIND OF HIS I'M FOR YEARS
RATHER THAN DIRECT TO CONSUMER
MATHIS. IN THIS TYPE OF SYSTEM
WE CAN PROVIDE EFFECTIVE
EQUITABLE CARE TAKE ADVANTAGE
OF THOSE NEW OPPORTUNITIES THAT
LIE AND TELEHEALTH WILL STILL
CONTROLLING COSTS. THIS TYPE OF
SETUP ALLOWS FOR IN PERSON CARE
TO BE SUBSTITUTED- BY SOME
VIRTUAL VISITS AND WHEN
APPROPRIATE AND NECESSARY PHONE
WITH ITS WHICH ALONGSIDE REMOTE
PATIENT MONITORING MONITORING
ALSO WHEN CLINICALLY
APPROPRIATE. TOGETHER BRINGS
TELEHOUSE PROMISE IN PROVIDING
BETTER MORE EFFECTIVE AND
EFFICIENT CARE TO FRUITION SO
I'M TO GIVE YOU AN EXAMPLE
LET'S SAY WE HAVE A PATIENT
MISTER STEVE BARELY VERY POORLY
CONTROLLED DIABETES- WE CARE
ABOUT THIS BECAUSE IT SENDING
ABOUT FOR THE LONG TERM-
COMPLICATIONS THAT LEAD TO
FOOT. AMPUTATIONS AS AN EXAMPLE
SO THIS IS A PATIENT THAT RIGHT
NOW YOU'D ALREADY BE SEEING ON
A MONTHLY BASIS BECAUSE OF THAT
POORLY CONTROLLED A WHIMSY.
YOUR PATIENT IS HERE FOR THEIR
VISIT THERE TO FURTHER BUT EXAM
REFORM THAT. IN SYSTEM THAT
ALLOWS THEM TO ACCEPT ACCESS
TELEHEALTH YOU SET HIM UP FOR A
VIDEO VISIT THE NEXT TIME. THE
PATIENT SEND YOU THE BLOOD
GLUCOSE LOG FOR YOUR REVIEW
BEFORE THE VISIT. AND IN A
VIRTUAL VISIT YOU CAN REVIEW
THAT IN DETAIL MAKE ADJUSTMENTS
TO THEIR INSULIN. BUT LET'S SAY
THEY DON'T HAVE THE NEEDED
INTERNET SPEED BECAUSE OF COSTS
AND SO DESPITE YOUR EXCELLENT
AND WE'LL SEE PATIENT CENTERED
VIDEO VISIT APP. YOU CAN'T
ACTUALLY LAUNCHED A VIRTUAL
VISIT SO IN THIS CASE YOU'RE
FORCED TO CALL THEM ON THE
PHONE. BUT YOU ACHIEVE THE SAME
CARE YOU WOULD HAVE BY VIDEO
YOU TITRATE PARENTS LINE. YOU
PLEASE REFER OVER THERE RIGHT
NOW CAN'T- EXAM THAT YOU'VE
DETERMINED THERE NOW DO YOU FOR
YOU SEND THEIR INSULIN
PRESCRIPTION TO THE PHARMACY.
AND ALL THAT TAKES THE SAME
TIME INCORPORATED THE SAME
MARKET WOULD HAVE TO GET IN
PERSON SUCH AS- AND IN IT AND
AS SUCH IT REPLACES- AN IN
PERSON FOLLOW UP VISIT. AND THE
NEXT TIME YOU SEE THEM IN
PERSON AND SO ON AND SO FORTH
THIS IS- A SYSTEM THAT WORKS-
BUT IS ALSO COST SAVING. IN THE
LONG TERM. NEXT LINE. BUT TO
AVOID UNDERSERVED VULNERABLE
POPULATIONS THE CORE COMPONENTS
OF IT THAT TELEHEALTH ECOSYSTEM
INFRASTRUCTURE THAT WE HAVE TO
PURSUE OUR FIRST AND FOREMOST
INCLUSIVE TECHNOLOGY SO RATHER
THAN JUST EXPECT OUR PATIENTS
TO ADOPT A SUB OPTIMAL SYSTEMS
OF TELE HEALTH CARE WE MUST
IMPROVE OUR DELIVERY SYSTEMS TO
MEET THEIR TECH CAPACITY AND
THEN WORK TO IMPROVE OUR
PATIENTS CAPACITY. NEXT
ENSURING EQUITABLE ACCESS TO
THE NECESSARY TECHNOLOGY IN
BROADBAND WITHOUT WHICH THEY
CANNOT COMPLETE VIDEO OF ESSEX
TECH SUPPORT WHO CAN WALK
PATIENTS THROUGH SIGNING UP OF
PORTALS AND VIRTUAL VISIT UP TO
HELP THEM TROUBLESHOOT IN REAL
TIME AND REQUIRING PAYMENT
PARITY FOR EQUAL CARE THAT- SO
THAT PROVIDERS CAN REALLY
PROVIDE THAT CARE THAT PATIENTS
IN THE SAFETY NET NEED.
BACKSIDE SO HAVING A VISION OF
EQUITY AND TELEHEALTH- MEANS
TAKING INTO ACCOUNT BOTH OUR
PATIENT CONSUMER BASE SO FOR
EXAMPLE THINKING ABOUT THE
LANGUAGES THAT ARE SOFTWARE AND
PLATFORMS ARE PROVIDED AND-
MEETING THE LANGUAGE NEEDS OF-
LIMITED ENGLISH PROFICIENCY
PATIENTS AT ALL POINTS OF
CONTACT IS REQUIRED BY VARIOUS
STATUTES- WE ALSO HAVE TO THINK
ABOUT- TAKE INTO ACCOUNT OUR
PROVIDER BASE WAS CARING FOR
THESE POPULATIONS DAY IN AND
DAY OUT AND- WHAT THEY'RE STILL
MISSING TO ENSURE VIRTUAL
ACCESS FOR THEIR- PATIENTS SO.
THE TECHNOLOGY EQUIPMENT MAYBE
REIMBURSEMENT FOR THAT
TECHNOLOGICAL SUPPORT FOR
PATIENTS. AND FINALLY
ACKNOWLEDGING THE REALITY THAT
VIDEO VISITS AT HOME MAY NOT BE
AN OPTION FOR SOME PATIENTS FOR
WHOM IT IS NECESSARY EVEN IN
THE LONG TERM. NEXT SLIDE. A
COMMITMENT TO PREVENTING
FURTHER DISPARITIES MEANS
SEEKING OUT THE IMPACT OF
SOCIAL AND STRUCTURAL
INEQUITIES IN DEALING CARE ACT
ACCORDINGLY- ADDRESSING THOSE
BARRIERS AND THAT AND NEEDS
THAT WE'VE IDENTIFIED NEXT LINE.
SO LONG TERM PAYMENT PARITY OR
VIRTUAL VISIT AS YOU ALL HAVE
RECOGNIZE MATTERS THERE AREN'T
NEW OAK ASSOCIATED COSTS THAT
COME WITH THE HEALTH DELIVERY
ESPECIALLY WITH AND UNDERSERVED
POPULATIONS INCLUDING THE
DEDICATED TECH SUPPORT WE'VE
DISCUSSED PATIENT CENTERED
EDUCATION AND DIGITAL LITERACY
AND PATIENT FRIENDLY PLATFORMS.
ADDITIONALLY A PIECE THAT IS
OFTEN LEFT OUT IS THAT AS A
PHYSICIAN THE WORK ON YOUR END
EXPERTISE YOU'RE CRYING IT'S
EQUAL WHETHER YOU'RE PATIENTS
IN FRONT OF YOU ARE ON VIDEO
AND IN CASES SUCH AS WITH
PATIENTS WITH LIMITED HEALTH OR
DIGITAL LITERACY. YOUR JOB IS
EVEN HARDER HOME VIA TELEHEALTH
IN AT THE TOP HEALTHCARE SYSTEM
LEVEL AND IN OUR CURRENT
ENVIRONMENT CANTERBURY IS
NEEDED TO ENSURE THAT THESE
VIRTUAL VISITS ARE ABLE TO MAKE
THEIR WAY- INTO OUR CLINICS AND
AS WE'VE TOUCHED ON- SUPPORTING
ALTERNATIVE TELEHEALTH OPTIONS
WHEN VIDEO CAPACITY IS NOT AN
OPTION- IT REQUIRES A COVERAGE
OF PHONE VISITS ACROSS PAYERS.
AND AFFORDABLE REIMBURSEMENT
FOR THESE EQUITABLE
REIMBURSEMENT MEANS HEALTH
INSURER COMPENSATES THE
HEALTHCARE PROVIDER AT A FAIR
PAYMENT RATE THAT ALSO TAKES
INTO CONSIDERATION THE ONGOING
COSTS NEXT LINE. TO REDUCE THE
NEED ARE DEPENDENT ON PHONE
VISITS AS A STOP GAP- WE FIRST
NEED TO ENSURE ACCESS TO THE
INFRASTRUCTURE THAT'S NECESSARY
FOR VIRTUAL VISITS FOR THOSE
PATIENTS THAT HAVE BEEN LEFT
BEHIND. IN A SIMILAR WAY TO
PROVISION OF NON EMERGENCY
TRANSPORT FOR LOW INCOME
PATIENTS THAT GETS THEM TO
THEIR IN PERSON APPOINTMENT
HERE SHOLD PURSUE METHODS OF
PROVIDING DIGITAL DEVICES. TO
PATIENTS NOT ABLE TO OBTAIN
THEM SO ENSURING DIGITAL ACCESS
TO VIRTUAL VISITS FOR OUR
VULNERABLE PATIENTS WILL ENSURE
THAT OWNING COUNTERS ARE ONLY
BE USED WHEN NECESSARY AND
CLINICALLY APPROPRIATE. NEXT
LINE. TO ENSURE EQUITABLE
ACCESS ACROSS PEERS INCLUDING
MEDIC HOW WE CAN STANDARDIZE
THE APPROACH TO COVERAGE AND
REIMBURSEMENT. REQUIRE SAME
BENEFITS REQUIRE THAT THE SAME
UTILIZATION REVIEW PROCEDURES
APPLY TO TELEHEALTH AS TO IN
PERSON ENCOUNTERS. NEXT SLIDE.
THANKS BYE. RIGHT NOW WE HAVE
TO FOCUS ON BUILDING UP THAT
INCLUSIVE TELEHEALTH ECOSYSTEM
WE'VE BEEN DISCUSSING SINCE WE
HAVE NOT YET REACHED THE POINT
WHERE PATIENTS AND PROVIDERS
HAVE THE NECESSARY
INFRASTRUCTURE TO IMMEDIATELY
DO AWAY WITH PHONE VISITS AND
UNDERSERVED THINGS- ESPECIALLY
AMID THE ON GOING PANDEMIC
WHERE YOU'VE GOT TO CONTINUE
PAYMENT PARITY FOR PHONE VISITS
FOR POPULATIONS WITHOUT VIDEO
CAPACITY WHILE COLBERT LINGERS
AND AFFORDABLE REIMBURSEMENT
FOR THESE VISITS IN THE LONG
TERM. OTHERWISE WE'RE PULLING
THE RUG OUTFROM UNDER OUR
PATIENTS WHO ARE ALREADY
BEARING THE BRUNT OF THIS
PANDEMIC. SIGN. I HAD TO
SUPPORT THE EXPANSION OF
TELEHEALTH SERVICES WE CAN FIND
PRIMARY CARE PROVIDER
INFRASTRUCTURE THAT IS REQUIRED
TO BE USER FRIENDLY AND
PROVIDES MULTILINGUAL SUPPORT
SO FOR EXAMPLE TELEHEALTH
PLATFORM IS CONTRACTING WITH
CLINICS CARING FOR THE SAFETY
NET CAN BE REQUIRED TO PROVIDE
WILL TIGHTLY WILL SUPPORT IN
ORDER TO DELIVER EQUITABLE
ACCESS. EXIDE MAINTAINING
QUALITY AND ENSURING OUTCOMES
WILL NEED TO BE A LONG TERM
PROCESS AS HAS HAS BEEN
MENTIONED NEXT LINE. AND PART
OF THIS PROCESS IS MAKING AN
EQUITY VISIBLE AND IDENTIFYING
AVENUES FOR SOLUTIONS THIS IS
GOING TO REQUIRE ONGOING
RESEARCH AND APPLYING THE
EVIDENCE IN OUR POLICY IN
ADDITION TO ASSESSING THE
HEALTH CARE SYSTEM COSTS AND
SAVINGS THAT TELEHEALTH BRINGS
WE NEED TO ASSESS OUR
TELEHEALTH SYSTEMS ON MEASURES
OF EQUITABLE ACCESS. INCLUDING
A REIMBURSEMENT STRUCTURES ARE
WILL NEED TO EMPLOY A
SYSTEMATIC APPROACH TO
MEASURING REPORTING AND
IMPROVING QUALITY AND OF COURSE
WE NEED TO MINIMIZE
INAPPROPRIATE UTILIZATION- I
WILL SAY THAT AS A PRIMARY CARE
DOCTOR- AGAIN SERVING THESE
POPULATIONS I CAN GUARANTEE YOU
I DON'T HAVE EXTRA TIME TO WHO.
HAS SOME VISITS WE'RE JUST YOU
KNOW- TO CHECK IN ON HOW
PATIENTS ARE- BUT AS- ALSO. NO
LANGUAGE ASSISTANCE SERVICES
CAN BRIDGE THE LINGUISTIC AND
CULTURAL GAPS THAT LIMITED
ENGLISH- PATIENT POPULATIONS
BASED IN THEIR ENCOUNTERS WITH
THEIR PROVIDERS WE WILL NEED TO
WHOLEHEARTEDLY COMMIT TO
BUILDING UP A LANGUAGE CAPABLE
WORKFORCE- AND THEN YOU KNOW IN
CLOSING. AS WE DEPLOY POLICY
AROUND TELEHEALTH SERVICE USE
WE CAN HELP ADDRESS AND
CAREFULLY AVOID FURTHER
CONTRIBUTING TO AN EQUITIES
WITHIN OUR ERA OF HEALTHCARE
DELIVERY BY ENSURING PAYMENT
PARITY FOR VIRTUAL VISITS
ACROSS PAYERS. REQUIRING
EQUITABLE REIMBURSEMENT FOR THE
USE OF TELEPHONE TO DELIVER
SERVICES IN REQUIRING THAT OUR
DELIVERY SYSTEMS ARE INCLUSIVE
OF THE VERY POPULATIONS THAT
THEY'RE INTENDED TO SERVE
THAT'S WHERE REGULATORY POLICY
CAN PROMOTE HIGH VALUE AND
EFFECTIVE CARE THAT WILL
ULTIMATELY- DRIVE. DOWN COSTS
NEXT LINE. SO MY REFERENCE NEXT
LINE TO MAKE MEN'S. AND THAT'S
IT NEXT SLIDE. VERY GOOD WELL
THANK THANK YOU VERY MUCH DR
NAYEF- IT TO BE A QUESTIONS THE
FIGURE. NO JUST THE FACT THAT-
YOU KNOW COVERED REALLY BROUGHT
ALL THESE INEQUITIES RIGHT TO
THE SERVICE FOR TELEPHONE
HEALTH CARE ACCESS AND- WE HAVE
TO LOOK AT ALL OPTIONS
AVAILABLE AND- I THINK WITH THE
TELEPHONE PIECES THERE- WE TAKE
THAT AWAY THEN IT'S INEQUITABLE
FOR SO MANY OF OUR-
CONSTITUENTS SO. I THANK YOU
VERY MUCH FOR PRESENTATIONS
WHILE THE- YES THANK YOU- AND I
AM JUST CURIOUS FROM YOUR
PERSPECTIVE A DOCTOR AND I A
IS. IS THERE AN ADDITIONAL
EVIDENCE YOU THINK WE NEED ON
YOU KNOW TELEHEALTH TELEPHONE
COVERAGE. OR DO YOU THINK WE
KNOW ENOUGH THERE'S ENOUGH OUT
THERE TO MAKE OUR POLICY
DECISIONS MORE PERMANENT. YOU
KNOW AND THAT'S A REALLY GOOD
QUESTION- YOU KNOW AND KIND OF
TYING THIS TO AN EARLIER
QUESTION ABOUT HOW MUCH
RESEARCH THERE IS IN PRIMARY
CARE AND HOW MUCH OF ADOPTION
THERE IS IN PRIMARY CARE. YOU
KNOW ONE OF THE THINGS AS WAS
MENTIONED AS THERE WAS A SLOW
ADOPTION- IN PRIMARY CARE TO
TELEHEALTH. AND SO THERE IS
DEFINITELY MORE RESEARCH THAT
IS GOING TO BE- FORTHCOMING AND
THAT ALREADY HAS STARTED TO
COME OUT JUST- AND THIS WEEK
THE JOURNAL OF THE AMERICAN
BOARD OF FAMILY MEDICINE-
PRODUCED. A SUPPLEMENT THAT HAS
A NUMBER OF STUDIES AND- AND SO
THERE IS. MORE DATA THAT IS
FORTHCOMING- THOUGH YOU KNOW AT
FROM- ANECDOTALLY I CAN TELL
YOU THAT IN THESE VULNERABLE
POPULATIONS- THAT IS THE
UNFORTUNATE- REALITY THAT OUR
PATIENTS- I FACED NOT ONLY. YOU
KNOW ONE ON THERE- SIDE BUT
ALSO ON THE PROVIDER SIDE AND
SO AT THE VERY LEAST AS I WAS
SAYING IN THEM IN THE DURING
THE TIME THAT WE ARE BUILDING
OUT THAT INFRASTRUCTURE- THIS
THE- TELEPHONE THE ONLY-
ENCOUNTERS ARE GOING TO BE
NECESSARY IT- IT IS. I CAN'T
EVEN IMAGINE. HOW YOU CANNOT.
REMOVE THOSE- REMOVE PAYMENT
FOR THOSE AND EXPECT FOR-
PATIENTS TO- NOT FURTHER FALL
THROUGH THE CRACKS. NO AND I
APPRECIATE APPRECIATE THAT
NIGHT AND I ABSOLUTELY
UNDERSTAND THAT SO. I'M CURIOUS
FROM FOR. IN THE COMMERCIAL
COVERAGE- WHY WHY SHOULD STATE
LOG DICTATE A MINIMUM PAYMENT
AMOUNT FOR TELEPHONE VISITS WE
DON'T NORMALLY SET PAYMENT
AMOUNTS IN STATUTE SO- THAT IN
THAT IT PROVIDES A PAYMENT
FLOOR. DO YOU HAVE ANY THOUGHTS
ON THE- YOU KNOW IT'S- THE IDEA
IS THAT YOU ARE PREVENTING THE
POSSIBILITY- THAT. THESE VISITS
ARE GOING TO BE- ONE THAT
THEY'RE GOING TO BE- AS THE
COST SHIFTING OVER TO- THE
PATIENT- AND THAT. IF THERE IS
NOT THAT PROTECTION OF THESE-
VIRTUAL VISITS WHICH IN FACT-
HAVE ADVOCATE CAN PROVIDE THAT
EQUAL CARE- THEN YOU ARE
MINIMIZING THAT ABILITY FOR
PATIENTS TO BE ABLE TO ACCESS
THEM- AND READ THAT REALLY IS
THE KEY AND- YOU KNOW. THAT
STANDARDIZATION IS IMPORTANT SO
THAT WE ARE NOT CREATING A
MULTI TIERED SYSTEM OF CARE FOR
OUR PATIENTS. SO YOU WOULD
ADVOCATE FOR A PAYMENT- AMOUNT
IN STATUTE. NUMBER OF PAYMENT
AMOUNT IN STATUTE MORE SO THE
STANDARDIZATION OF THE EQUAL
PARITY TO WHATEVER- ALREADY
KIND OF CONTRACTED- VISIT-
PAYMENT IS- FOR AN EQUAL VISIT
SO RIGHT NOW- WE HAVE
TRANSITIONED OVER TO TIME BASED
BILLING AND IF THE CARE THAT IS
PROVIDED- IS EQUAL AND- IS
SIMILAR IN TIME THEN YOU THAT
IS THAT THAT KIND OF- MINIMUM
REQUIREMENT WOULD BE THAT THAT.
WOULD BE THE MINIMUM
REIMBURSEMENT. THANK YOU- SO-
IF I'M A PATIENT AND JUST HAD
SURGERY OR GOT LAB RESULTS AND
I CALL MY DOCTOR WITH THE
QUESTION AND- DOCTOR CALLS BACK
TO CHECK ON ME WOULD YOU WOULD
YOU CONSIDER THAT SHOULD BE A
BILLABLE ENCOUNTER. YOU KNOW
THERE ARE CERTAIN SCENARIOS
JUST- HAS OF TOMATO WAS-
MENTIONING THAT ARE PART OF-
ENCOUNTERS THAT WE ARE ALREADY.
HAVING SO FOR EXAMPLE- WE- HAVE
A PATIENT A COMPLICATION JUST
AS YOU SAID WE HAVE TO- AND
SPEAK TO THE SPECIALIST WE HAVE
TO CALL THEM BACK WITH LAB
RESULTS ALL OF THAT. IS BEING
INCORPORATED INTO THE TIME THAT
IS SPENT ON THAT- GIVEN
ENCOUNTER SO IT'S NOT A
SEPARATE BILLABLE ENCOUNTER
IT'S THAT IT'S BEING
INCORPORATED- AND ACCOUNTED FOR
IN THE LARGER AND COUNTER. SO
WHICH WOULD BE CONSISTENT WITH
OUR SORT OF CAPITATED OR WHOLE
PERSON CARE MODEL BUT NOT
NECESSARILY IN WHAT I WAS
GETTING AT IS A IS A IN SOMEONE
IN A FEE FOR SERVICE ATMOSPHERE
WOULD YOU CONSIDER THAT A
BILLABLE ENCOUNTER. AND SO KIND
OF THE PART OF THE COMPLEXITY
WAY THINKING ABOUT- VALUE BASED
PAYMENT IS THAT. YOU KNOW WE'RE
NOT QUITE THERE YET- IF
DESIGNED WELL- THESE
ALTERNATIVE PAYMENT MODELS ARE
CAPABLE OF DRIVING COST SAVINGS
AND VALUE IMPROVEMENTS IN THE
LONG TERM- BUT YOU KNOW RIGHT
NOW THAT LANDSCAPING CLUES MANY
UNDER PERFORMING MODELS WHICH
HAVE FAILED TO PRODUCE THAT
DESIRED PRACTICE-
TRANSFORMATION. AND YOU KNOW IT
THAT DOESN'T MEAN THAT WE
SHOULD ABANDON VALUE BASED
PAYMENT JUST THAT WE ARE NOT
YET THERE AND- SO THIS IS- WHY
IN THE INTERIM WE NEED TO THINK
ABOUT HOW CAN WE- MEET PATIENTS
WHERE THEIR ACT- ALLOW THEM TO
BE ABLE TO ACCESS THEIR
PROVIDERS IN. THE IN THE
MODALITIES THAT THEY HAVE
AVAILABLE TO THEM- WHILE WE ARE
IN THE LONG TERM THINKING ABOUT
HOW WE CAN- APPLY A VALUE
BASED. PAYMENT SYSTEM. SO THEY
ARE THE PREVIOUS SPEAKER-
DOCTOR MAROTTA- SAID THAT HE
THOUGHT THAT YOU KNOW MAYBE.
TELEPHONE SHOULD BE TELEPHONE
SERVICES SHOULD SHOULD HAVE
SORT OF KIND OF A SUNSET
NECESSARILY- AND MAYBE A RE
EVALUATION AFTER A COUPLE OF
YEARS- HOW DO YOU FEEL ABOUT
THAT. I THINK THAT THAT'S A
REASONABLE APPROACH BUT AGAIN I
THINK YOU ALWAYSHAVE TO
CONSIDER AT THE END OF THE DAY
THERE IS GOING TO BE A SEGMENT
OF THE POPULATION- THAT
ULTIMATELY WILL NOT HAVE ACCESS
TO- THE THOSE VIRTUAL VISITS
THAT WE WOULD LOVE FOR ALL OF
OUR PATIENTS TO HAVE ACCESS TO
YOU. AND I THINK THAT'S
SOMETHING THAT YOU HAVE TO
CONSIDER AND THAT- NEEDS TO BE
ACCOUNTED FOR- INCLUDING FOR
THE LONG TERM- AND SO- YOU KNOW
IT WE IT WOULD BE- YOU KNOW
NAIVE. TO SAY THAT EVENTUALLY
WE WILL GET TO THAT POINT- WE
MAY BE ABLE TO GET TO THAT
POINT BUT IT'S GONNA TAKE- TIME
AND SO- TO BE ABLE TO PREDICT
THAT- SUNSET DATE YOU KNOW WITH
SOMETHING LIKE TWO YEARS. YOU
KNOW I THINK IT'S- GONNA BE
HARD PRESSED TO BE ABLE TO KNOW
WHEREWE'RE GOING TO BE YEAH IN
THOSE. TWO YEARS- YOU KNOW AS
WE KNOW THESE CHANGES ARE AT
THE INFRASTRUCTURE LEVEL
CHANGES- TAKE A LOT OF TIME-
AND SO. YOU KNOW THINGS THAT W
CAN DO ON HAD HE- PATIENT SIDE
TO MINIMIZE- FOR EXAMPLE AT THE
OVER UTILIZATION AND THAT- THE
CONCERNS HAVE- HAD BEEN BROUGHT
UP ABOUT FOR EXAMPLE PHONE
VISITS SO- THINKING ABOUT-
HAVING AND THE- AMBULATORY
TRIAGE. ALGORITHMS WHERE YOU
CAN- YOU KNOW DESIGNATE WHAT
TYPE OF VISITS CAN GO INTO-
VIRTUAL VISITS PHONE VISITS
WHAT PATIENTS NEED TO BE SEEN
AND PERSON AND SO- YOU KNOW I
THINK IT'S- THINKING ABOUT THE
SYSTEM MORE BROADLY- AND-
ACCOUNTING FOR THE FACT THAT
AGAIN SOME PATIENTS- YOU KNOW
VIRTUAL. VISITS WILL NEVER BE
AN OPTION. ALL RIGHT WELL THANK
YOU MUCH AND I YOU KNOW I
COMPLETELY RECOGNIZE THAT I'D
AT THE LAST THING YOU WANT TO
DO IS TAKE AWAY THE ONLY
MODALITY SOMEBODY WOULD HAVE TO
BE ABLE TO. TO HAVE A VISIT-
AND I RECOGNIZE THE- THE HUGE
INFRASTRUCTURE CHALLENGES WE
HAVE WITH TRYING TO GET TO A
POINT WHERE WE CAN ACTUALLY.
HAVE THE INFRASTRUCTURE
AVAILABLE FOR EVERYBODY TO BE
ABLE TO TAKE ADVANTAGE. OF A
VIDEO VISIT OR OR SOME OTHER-
TYPE OF MODALITY THERE. AND
EVEN ONCE YOU GET TO THAT POINT
THEY'RE STILL GOING TO BE
PEOPLE WHO DON'T HAVE THE
TECHNOLOGY TO BE ABLE TO DO
THAT OR IN THE CASE OF OLDER
PATIENTS. WHO MAY NOT.
UNDERSTAND HOW TO USE THE
TECHNOLOGY OR HAVE DEMENTIA OR
OTHER OTHER HEARING ISSUES AND
THINGS LIKE THAT SO- SO. THAT'S
THERE'S A LOT OBVIOUSLY THERE'S
A LOT A LOT TO CONSIDER HERE-
AND- I JUST IN MY OWN MIND HI I
HAVE A DIFFICULT TIME.
CONSIDERING THAT THERE IS
PARITY BETWEEN THE TELEPHONE
VISIT AND ITALO TELE TELE- A
VIDEO CONFERENCING VISIT. THOSE
IN MY OWN MIND DON'T DON'T.
THEY'RE NOT EQUITABLE AND SO
THAT'S WHY I'M STRUGGLING A
LITTLE BIT WITH THE PAYMENT
ISSUE HERE BECAUSE I IT'S IT
IS. IT IS A VERY THEY ARE VERY
DIFFERENT AND EVEN- MR CORBETT-
IN HIS CHART TALKED ABOUT YOU
KNOW THE VALUE OF THE SOME OF
THIS IS SOMEONE IS A LITTLE BIT
INCONCLUSIVE AND- BECAUSE THERE
ISN'T A LOT OF EVIDENCE OUT
THERE SO. BUT I WOULD BE CLEAR
I DON'T I'M NOT TRYING TO CUT
AND WANT TO CUT PEOPLE OFF BUT
THAT'S THE ONLY THING THEY HAVE.
BUT I DO HAVE THIS YEAR YOU
KNOW IT'S HARD FOR ME IN MY OWN
MIND TO JUSTIFY IT AS PARITY-
PARITY MEANS. THAT THEY'RE
EQUAL. IN ANY CASE. ABSOLUTELY
AND I AM- IT IS A VERY REAL
CONCERN SO FOR EXAMPLE THE-
EXAMPLE THAT WAS BROUGHT UP
ABOUT- TO PEDIATRIC VISIT AND
DOING FOR AT AN EXAM FOR
ORTEGA'S MEDIA YOU CAN EXAMINE
IT. BABIES YEARS VIA VIDEO IT'S
JUST NOT POSSIBLE SO YOU KNOW
PATIENT NEEDS TO BE SEEN AND
PERCENT SO OF COURSE THERE IS
NOT GOING TO BE PARITY BETWEEN
ALLEN AND ACUTE CARE VISIT FOR-
RULE OUT OF TIGHTEST MEDIA- AND
IT OVER VIDEO OR PHONE-
BIRTHDAYS IN PERSON. HOWEVER
YOU KNOW THAT'S NOT THE CONTEXT
THAT WE'RE TALKING ABOUT HERE
IN TERMS OF CHRONIC CARE
MANAGEMENT AND EXAMINE THE
EXAMPLE THAT I GAVE. THAT
DIABETES IS- PATIENTS RIGHT SO-
WE CAN ABSOLUTELY DO AND
PROVIDE THE SAME EXACT CARE THE
SAME LEVEL OF CARE THAT THE-
AT. THE SAME LEVEL EXPERTISE
THE SAME LEVEL OF TIME VIA A
VIRTUAL VISIT AS WE WOULD. THE
PHONE VISIT AND- YOU KNOW
PHYSICIANS- ARE GOING TO BE
ABLE TO APPLY THOSE TYPES OF-
YOU KNOW SELF SELECTION A
LITTLE BIT- PATIENTS. WE MAY
NOT BE ABLE TO APPLY THAT FROM
THE BEGINNING AND THAT'S WHY I
THINK WE NEED TO INCORPORATE
THINGS LIKE ALGORITHMS THAT
ARE- GOING TO BE- NOT JUST
BLANK ALGORITHMS FOR ALL BUT
REALLY BETTER TAILORED TO A
PATIENT PRACTICE. AND THAT ARE
TAILORED TO A PATIENT
POPULATION- AND SO THAT'S WHAT
I WAS KIND OF GETTING AT IN
TERMS OF NEEDING TO REALLY
THINK ABOUT YOUR PATIENT
POPULATION- WITH YOU KNOW AND
CENTERING WHAT WE CALL IT AND-
CRITICAL RACE THEORY- CENTERING
AT THE MARGIN SO THAT WE ARE
NOT- EXCLUDING. THOSE AT THE
MARGINS. GREAT WELL THANK YOU
KNOW MISS GADKARI HAD A QUICK
IF I JUST SEMANTIC BE- I.
RECENTLY HAD WAS APPROACH BY
AGRA. BUSINESS AND OF DAVE WANT
TO MAKE SURE THEIR PREVENTATIVE
HEALTHCARE FOR THEIR EMPLOYEES
WHICH IS A LOT IN THE FARM
FARMING WORLD. AND THEY'RE
GOING TO ACTUALLY SET UP AN
OFFICE SPACE ON THEIR SITE SO
SOMEBODY NEEDS TO DO A HEALTH
CARE TELEHEALTH MEDICINE CALL
ONSITE. DURING WORK HOURS SO
THEY DON'T HAVE TO LEAVE. AND
THAT THEY HAVE ACCESS TO
TELEHEALTH AND- THAT REALLY GET
YOU KNOW GIVES ME CHILLS TO
THINK WHAT WE'RE OUR NEW
NORMAL. AND THE BE ABLE TO-
HAVE YOUR HEALTH CARE TAKING
CARE OF MAYBE ON SITE AND MAYBE
IF YOU HAVE TO GO INTO THE
DOCTOR BUT- FOR PREVENTIVE
HEALTH CARE I THINK THAT. IT'S
JUST BEEN A REALLY HELP A LOT
OF THESE BUSINESSES IF THEY
WERE TO BE ABLE TO HAVE ON SITE
THEY HAVE THE COMPUTER THEY'VE
GOT THE INTERNET KIND
CONNECTIVITY. SO I JUST THINK
SO MANY PEOPLE WE LOOKING
OUTSIDE THE BOX AND SO I JUST
WANTED TO SHARE WITH YOU THAT
THERE ARE PEOPLE. AND IT'S ALL
FARMERS THAT ARE THINKING
OUTSIDE THE BOX OF HOW CAN THEY
HELP OUR FARMWORKERS ARE- YOU
KNOW ONLINE- EMPLOYEES SO. A
THERE'S SO MUCH ROOM GROWTH.
AND SO THANK YOU FOR YOUR
PRESENTATION DID A GREAT JOB.
THANK YOU WATSON GREAT THANK
YOU SO MUCH DR NAYEF REALLY
REALLY APPRECIATE IT. THANK YOU
THANK YOU SO MUCH. WE MOVE ON
TO OUR LAST PANEL TO SPEAKERS-
FIRST WE HAVE DOCTOR WILL LIFE
BORN DIRECTOR WILL LIE FOR NEXT
WHAT WE CAN PROMOTED TO DR FOOD
LIKE I GUESS A DIRECTOR WILL
LIGHT BORN WHO IS THE DIRECTOR
OF THE DEPARTMENT OF HEALTH
CARE SERVICES. AND J. C. COOPER
WHO IS THE CHIEF DEPUTY
DIRECTOR FOR HEALTH CARE
PROGRAMS IN CALIFORNIA STATE
MEDICAID DIRECTOR I'LL SPEAK
ABOUT THE DEPARTMENT'S RECENTLY
RELEASED TELL A HOTEL HEALTH
POLICY. SO TORNADO. DOCTOR
WORKS WITH MEMBERS- WELL LIKE
INSTANCE- I'M GOING TO BE VERY
BRIEF AND THEN I'LL TURN IT
OVER TO THE SCHOOL FOR. ALL THE
DEPARTMENTS AS YOU KNOW HAS
PROPOSED A TELEHEALTH POLICY
COMPANY TRAILER BILL TO
CONTINUE MOST OF THE CURRENT
FLEXIBILITIES FOLLOWING THE END
OF THE COLD. PUBLIC. HEALTH
EMERGENCY. OUR GOAL HAS BEEN
CAP. ON THE VALUE LESSONS
LEARNED FROM THE- OF TOTAL.
KERR DURING EMERGENCE. THE
INCREASED TAX. TELEHEALTH WAS
MADE. WELL THE SAME TIME TO OUR
FOR. ON THE OF WELL NOW YOU
BASED PAYMENTS. HEALTH EQUITY
AND- HEALTH MATTERS. OR
PROPOSAL HOST THE ON SCHOOL.
AND I WANT TO EMPHASIZE ITS HER
ROOM FOR EXT. HAS ALTERED
PAYMENT MODELS WILL DEVELOP OR
CLINIC PART. SO WITH THAT LET
ME TURN IT OVER TO. JC COOPER
WALKING THE DETAILS OF THE
POLICY GREAT THANK YOU DIRECTOR.
GOOD AFTERNOON- SO IN TWO
THOUSAND NINETEEN- THE
DEPARTMENT OF HEALTH CARE
SERVICES GREATLY EXPANDED OUR A
TELEHEALTH- POLICY- WE ENGAGED
WITH AN EXTENSIVE AMOUNT OF
STAKEHOLDERS PUBLIC COMMENT TO
INFORM THAT POLICY REFINEMENT-
AND IT WAS ROLLED OUT- IN BOTH
FEE FOR SERVICE AND MANAGED
CARE. ON IN YOU HAD SEEN SOME
INCREASE IN- TELEHEALTH PRIOR
TO THAT- HOWEVER BASED ON ALL
OF THE DATA PRESENTED TODAY AND
PRESENTED BY THE DEPARTMENT
DURING THE PUBLIC HEALTH
EMERGENCY BOTH THE FEDERAL
GOVERNMENT AND- DH YES QUICKLY
IMPLEMENTED. A NUMBER OF
FLEXIBILITIES AROUND TELEHEALTH
ADD MANY NO WOULD HAVE TALKED
ABOUT TODAY- FOR CERTAIN PARTS
OF THE PUBLIC HEALTH EMERGENCY
THAT WAS ONE OF THE MAIN WAYS
YOU COULD RECEIVE. A CARE FROM
A POSITION I'M MORE CLINICAL
MEMBERS I'M JUST TO KIND OF
HIGHLIGHT SOME OF THE TEMPORARY
POLICY RECOMMENDATIONS ARE
FLEXIBILITY THAT WERE PUT IN
PLACE DURING THE CALL THE-
NINETEEN PUBLIC HEALTH
EMERGENCY I THINK PEOPLE ARE
TRACKING THAT. YOU SAID XP VIEW
FOR PROVIDERS TO RENDER. ALL
APPLICABLE MEDIC HOUSE ARE
VERSES THAT CAN BE
APPROPRIATELY PROVIDED D. AS
VIA TELEHEALTH MODALITIES WAS
PUT IN PLACE- INCLUDING
HISTORICALLY A NOT IDENTIFIED
OR REGULARLY PROVIDED VIA
TELEHEALTH- IN AREAS SUCH AS
HOME COMMUNITY BASED SERVICES.
LOCAL EDUCATION AGENCY OR ELLIE
A SERVICES AND ARE TARGETED
CASE MANAGEMENT SERVICES SO
THERE WAS A GREAT EXPANSION OF
CROSSED ALL DELIVERY SYSTEMS-
DURING THE PUBLIC HEALTH
EMERGENCY. ADDITIONALLY BE
ALLOWED TELEHEALTH MODALITIES
TO BE PROVIDED FOR NEW AND
ESTABLISHED PATIENT A DURING
THE PUBLIC HEALTH EMERGENCY.
ALLOWED MANY COVERED SERVICES
TO BE PROVIDED VIA TELEPHONIC
AUDIO ONLY FOR THE FIRST TIME
THAT WAS NOT PREVIOUSLY A
WIDESPREAD POLICY AT THE
DEPARTMENT OF HEALTH CARE
SERVICES. ARE WE ALLOWED PER
PAYMENT PARITY BETWEEN IN
PERSON FACE TO FACE SYNCHRONOUS
TELEHEALTH AS WELL AS
TELEPHONIC AUDIO I'M ONLY
DURING THE PUBLIC HEALTH
EMERGENCY WHICH INCLUDED. AT
UACS AND RURAL HEALTH CLINICS
BOTH IN MANAGED CARE AND BE FOR
SERVICE. WE WAIT THE SITE
LIMITATIONS FOR BOTH PROVIDERS
AND PATIENTS- FOR EDU AGENCIES
IN RURAL HEALTH CLINICS I WOULD
ALLOW THE PROVIDER OR THE
BENEFICIARY TO BE IN LOCATIONS
OUTSIDE OF THE CLINIC- AND OR
THEIR HOME RESPECTIVELY. AND
THEN LASTLY I WE IMPLEMENTED-
AND ALLOWED FOR THE EXPANDED
ACCESS TO TELEHEALTH. VIA THE
GOOD FAITH EXEMPTIONS AND UP
FEDERAL FLEXIBILITY IS FROM THE
OFFICE OF CIVIL RIGHTS
REGARDING- ADDITIONAL
FLEXIBILITIES ON HIT THE
REQUIREMENTS DURING THE PUBLIC
HEALTH EMERGENCY. I WE SAW
SIGNIFICANT INCREASES OF
UTILIZATION A REGARDING
TELEHEALTH- IN TWO THOUSAND
NINETEEN YOU HAD ABOUT TWO
HUNDRED AND EIGHTY FIVE VISITS
PER ONE HUNDRED THOUSAND
BENEFICIARIES. RECEIVING
TELEHEALTH I'M IN IN TWENTY
TWENTY IF YOU WILL CLOSER TO
YOU- NINETY ARE SORRY
900-021-0000 VISITS PER ONE
HUNDRED THOUSAND. EACH GIVEN
MONTH- WE DID SEE HIGHER
UTILIZATION OF TELEHEALTH AMONG
FEMALE- WE ALSO SAW THE HIGHEST
UTILIZATION AROUND EIGHTEEN TO
SIXTY FOUR YEAR OLD. I'M IN
SIGNIFICANTLY HIGHER
UTILIZATION IN MANAGED CARE
VERSES ARE FEE FOR SERVICE
ENVIRONMENT. OF FOR EXAMPLE WE
HAD SIX THOUSAND EIGHT HUNDRED
AND FIFTEEN PER ONE HUNDRED
THOUSAND IN MANAGED CARE VERSUS
ONE THOUSAND TWO HUNDRED AND
FORTY TWO IN P. FOR SERVICE. A
FEW OTHER THINGS REGARDING
UTILIZATION OF FOR OUR OVERALL
AND UTILIZATION OF TELEHEALTH
FOR NON BEHAVIORAL HEALTH.
VISITS WE SAW A. THIRTY EIGHT
PERCENT- IN. OF FOUR SORRY FOR
BEING HEALTH JUST TO BE CLEAR
BECAUSE THIS IS COME UP A LOT
WE WANT TO MAKE SURE WE GIVE
YOU SOME STAFF ON THAT. I
DURING 202038% OF NON SPECIALTY
MENTAL HEALTH VISITS A WARRANT
TELEHEALTH VERSUS 0% IN TWO
THOUSAND NINETEEN. 51% FOR MILD
TO MODERATE- BEHAVIORAL HEALTH
SERVICES. AND TWENTY TWENTY
VERSES 1% TWO THOUSAND NINETEEN
AND 27% OF MENTAL HEALTH
SERVICES SPECIALTY MENTAL
HEALTH IN TWENTY TWENTY VERSUS
ZERO IN TWO THOUSAND NINETEEN.
SO YOU CAN CLEARLY SEE THAT
THERE WAS A GREAT EXPANSION
BOTH IN B. I'M NOT BEHAVIORAL
HEALTH AS WELL AS THE
BEHAVIORAL HEALTH ACCESS TO
TELEHEALTH DURING PUBLIC HEALTH
EMERGENCIES. BUT STILL SEEING
CLEARLY THAT A LARGE NUMBER
PROVIDERS DID NOT UTILIZE ON
TELEHEALTH SERVICES. DURING THE
TWENTY TWENTY A TIME PERIOD AND
PUBLIC HEALTH EMERGENCY. I'M SO
DH THE AIRPORT A PROPOSAL WHICH
WERE WALKING THROUGH TODAY. WE
DO BELIEVE THAT THE
RECOMMENDATION- IS BOTH
REASONABLE AND BALANCED IN
TERMS OF PROMOTING APPROPRIATE
STANDARDS OF KERR. PROVIDING
ACCESS TO QUALITY HEALTHCARE
SERVICES- HELPING TO ADVANCE
EQUITY AND AVAILABLE
AVAILABILITY OF MULTIPLE
MODALITIES OF TELEHEALTH ACROSS
MULTIPLE DELIVERY SYSTEMS- THIS
ALL BEING DONE BY MAINTAINING
BENEFICIARY CHOICE. PRESERVING
PROVIDER FLEXIBILITY I WITHIN
THE PROPOSAL AND PROTECTING
INTEGRITY OF THE MEDICARE
PROGRAM BOTH FROM A QUALITY AND
A FISCAL PERSPECTIVE. WE TOOK
IN A NUMBER OF PIECES AND
OUTLINED SOME GUIDING
PRINCIPLES FOR OURSELVES AS WE
PUT FORWARD THE PROPOSAL
INCLUDING EQUITY ACCESS
STANDARD OF CARE PATIENT CHOICE
CONFIDENTIALITY STEWARDSHIP AND
PAYMENT APPROPRIATENESS. SO NOW
I WILL GO OVER OUR RECOMMENDED-
POLICY RECOMMENDATIONS FOR
TELEHEALTHIN MEDIC CAL- AFTER
THE END OF THE PUBLIC HEALTH
EMERGENCY ONE THING I WOULD
JUST LIKE TO HIGHLIGHT HERE IS
THAT OUR PROPOSAL HAS A
PROPOSED EFFECTIVE DATES FOR
THESE CHANGES OF JULY ONE OF
TWENTY TWENTY ONE. HOWEVER THAT
IS FROM THE FEDERAL APPROVAL
AND WITHIN OUR A STATE PLAN AS
YOU GET THEIR WAIVERS WITHIN-
APPROVALS WITH CMS HOWEVER ALL-
TELEHEALTH FLEXIBILITIES THAT
HAD BEEN ENACTED THROUGH THE
PUBLIC HEALTH EMERGENCY WOULD
CONTINUE TO HELP THE END OF THE
PUBLIC. HEALTH EMERGENCY WHICH
IS CURRENTLY SLOTTED UP FOR
DECEMBER OF TWENTY TWENTY ONE
AS CURRENTLY ANNOUNCED BY THE
CURRENT ADMINISTRATION. IN SO-
THOSE WOULD EXTEND UNTIL THAT
TIME I'M HOWEVER WE DO THINK
IT'S IMPORTANT TO INFORM
PROVIDERS PLANS AND OTHERS
ABOUT THE PROPOSAL WOULD BE AT
THE END OF THE PUBLIC HEALTH
EMERGENCY SO THEY CAN PLAN
ACCORDINGLY THAT WE HAVE ALL
APPROVALS IN PLACE BY THAT TIME
AND THAT IS WHY WE HAVE STILL
RECOMMENDED THE JULY ONE START
DATE- BERMAN APPROVAL POINT OF
VIEW NOT TAKING AWAY THE
FLEXIBILITIES. ALLOTTED DURING
THE PUBLIC HEALTH EMERGENCY. SO
NOW WALK THROUGH THE
RECOMMENDATIONS THAT THE ACS IS
PUTTING FORWARD- WE ARE
RECOMMENDING TO ALLOW FQHCS AND
RURAL HEALTH CLINIC PROVIDERS
TO ESTABLISH NEW PATIENT-
LOCATED WITHIN- IT'S FEDERALLY
DESIGNATED SERVICE AREA THROUGH
SYNCHRONOUS TELEHEALTH. PRIOR
TO THE PUBLIC HEALTH EMERGENCY
THAT IS NOT SOMETHING FQHCS.
ARE COULD DO. WE ARE RECORD TO
ME PERMANENT THE ROOM OF THE
SITE LIMITATIONS FOR FQHCS AND
RURAL HEALTH CLINICS. OF FOR
EXAMPLE ALLOWING THE PROVIDER-
TO PROVIDE SERVICES TO THE
BENEFICIARY. AND THE
BENEFICIARY'S HOME OR PROVIDER
OUTSIDE OF THE OFFICE SPACE- WE
ARE EXPANDING SYNCHRONOUS AND
ASYNCHRONOUS TELEHEALTH
SERVICES TO NINETEEN FIFTEEN C.
WAIVERS. FOR THE CHART- TCM
PROGRAM AND ELLIE A BOB PROGRAM.
WE ARE RECOMMENDING ADDING
SYNCHRONOUS TELEHEALTH IN
TELEPHONIC AUDIO ONLY THE STATE
PLAN DRUG MEDI CAL. WE ARE
PROPOSING TO REQUIRE PAYMENT
PARITY BETWEEN IN PERSON FACE
TO FACE VISITS AND SYNCHRONOUS
TELEHEALTH MODALITIES- WINDOWS
AS SERVICES OF COURSE MEET ALL
OF THE ASSOCIATED REQUIREMENTS
WITH THE UNDERLYING BUILDING
CODES BEING USED. THIS WOULD
INCLUDE FOR FQHCS ESSENTIALLY
ALLOWING THE FQHC TO BE PAID
THEIR PPS RATE FOR BOTH THE IN
PERSON OR THE SYNCHRONOUS
TELEHEALTH- HE WOULD BE
REQUIRED IN BOTH FEE FOR
SERVICE AND MAIN MANAGED CARE
DELIVERY SYSTEMS UNLESS OF
COURSE THE MANAGED CARE PLAN
AND A NETWORK PROVIDER MUTUALLY
AGREED TO A SEPARATE
REIMBURSEMENT METHODOLOGY. WE
ALSO ARE PROPOSING TO EXPAND
THE USE OF TELEPHONIC AUDIO
ONLY SERVICES ON THAT IS ONE
THING THAT I THINK SOME PEOPLE
HAVE MISUNDERSTOOD REGARDING
THE DEPARTMENT'S PROPOSAL WE
ARE PROPOSING- TO ALLOW FOR
TELEPHONIC AUDIO ONLY SERVICES
AS WELL AS VIRTUAL
COMMUNICATION SERVICES. HOWEVER
THE DEPARTMENT IS NOT
RECOMMENDING THAT WE PAID. OFF
FOR THOSE SERVICES WE DO THINK
THEY SHOULD BE SUBJECT TO A
SEPARATE FEE SCHEDULE- IN THAT
ARE THERE FOR WOULD NOT BE
BILLABLE BY FQHCS. DH CS
CONSULTED WITH CMS REGARDING
THIS PROPOSAL- IT IS A BILLABLE
PROVIDER PROVIDE SERVICES WE
ARE REQUIRED TO PAY THE PPS
RATE FOR AT UACS AND RURAL
HEALTH CLINICS. AND SENT OUR
PROPOSAL RECOMMENDS THAT THERE
WOULD NOT BE PAYMENT PARITY FOR
TELEPHONIC OD- ARE YOU ONLY
SERVICES. WE HAVE NOT
RECOMMENDED TO IMPLEMENT AND
ACTUALLY SEE THAT THIS TIME.
HOWEVERI WOULD KNOW THAT WE
WOULD DEFINITELY WORK WITH
FQHCS THAT WANT TO PARTICIPATE
IN THE ALTERNATIVE PAYMENT
METHODOLOGY TO ALLOW FOR THAT
AS WE CONTINUE THAT POLICY
WORK- AND LASTLY WE DO PROPOSED
AND THAT THE- WE WOULD
CONTINUE. TO PROVIDE TELEHEALTH
SERVICES IN THE TCM PROGRAM
ELLIE A BOP- HOWEVER WOULD JUST
KNOW SINCE THEY ARE A COST
BASED REIMBURSEMENT METHODOLOGY
AND THAT IS HOW WE WOULD SET
THE PAYMENT RATES ARE
CONTINUOUSLY. WITHIN THOSE
SERVICES. I TO BE CLEAR THE AGE
IS WRECK. THE CONTINUE. OF THE
FOLLOWING- TEMPORARY CODE
NINETEEN PUBLIC HEALTH
EMERGENCIES- THAT INCLUDE
PAYING A TELEPHONIC AUDIO ONLY
MODALITIES AS A BILLABLE VISIT
FOR FQHCS REIMBURSED AT THE PPS
RATE- A TELEPHONIC AUDIO ONLY
MODALITIES. I WOULD NOT BE
ALLOWED TO BE USED TO ESTABLISH
A NEW PATIENT- WE STRONGLY
RECOMMEND THAT THAT ONLY BE
USED FOR ESTABLISHED PATIENTS
WERE THERE'S ALREADY A
RELATIONSHIP BETWEEN THE
PROVIDER. AND THE PATIENT
THEMSELVES- WE ALSO ARE
RECOMMENDING THAT PAYMENT
PARITY HAS MENTIONED FOR
TELEPHONIC AUDIO ONLY
MODALITIES AND VIRTUAL
COMMUNICATIONS- BE SUBJECT TO A
SEPARATE- FEE SCHEDULE. AND
THEN LASTLY JUST WANT TO
CLARIFY MAKE SURE PEOPLE ARE
TRACKING THAT THE FEDERAL
GOVERNMENT- PROVIDE FOR THE-
POLICIES FOR REIMBURSEMENT FOR
TRIBAL AT SIX THIRTY A. CLINICS
AND SO WE WOULD BE REVERTING
BACK. I DO WHATEVER THE FEDERAL
GOVERNMENT'S DEBT FOR POLICIES
THERE HOWEVER ANY- TRIBAL
PARTNERS WHO ARE CONVERTING TO
THE TRIBAL FQHCS WHICH RECENTLY
WAS APPROVED BY CMS. I WOULD BE
SUBJECT TO WHATEVER RULES ARE
APPLICABLE TO FQHCS AND RURAL.
HEALTH CLINICS WITHIN THIS
PROPOSAL. IN THE DEPARTMENT
PROPOSAL A CHARGE THAT BREAKS
DOWN. CODE NINETEEN PUBLIC
HEALTH EMERGENCY- PROPOSED- IN
THIS PROPOSAL BY DELIVERY
SYSTEM IN BY EACH OF THE
TELEHEALTH MODALITIES I AM NOT
GOING TO GO THROUGH THAT BUT IT
IS THE REFERENCE FOR PEOPLE
WHO. ARE INTERESTED IN THE
DETAILS ACROSS THE DELIVERY
SYSTEM I'M AND THEN JUST WOULD
NOTE- THERE ARE NUMBER OF
THINGS WHICH THAT. THE STATE
WOULD NEED TO DO TO IMPLEMENT
THIS PROPOSAL AND INCLUDING ON
THE BUDGET PROPOSAL BEFORE THE
LEGISLATURE. FOR CONSIDERATION
REGARDING THE ADDITION OF
REMOTE PATIENT MONITORING OF
FOR EXAMPLE WE DID NOT EXPAND
REMOTE PATIENT MONITORING
DURING THE PUBLIC HEALTH
EMERGENCY AND THAT IS NOT
SOMETHING THAT WAS PREVIOUSLY
AVAILABLE. AND MEDICARE THAT IS
A PROPOSAL UP FOR
CONSIDERATION- WE WILL HAVE
PROPOSED TRAILER BILL WE WOULD-
IMPLEMENT VARIOUS WAIVER STATE
PLANS THAT ARE. THE MOST
NOTABLE I THINK GIVEN THAT
THERE IS STILL CONFLICTING
RESEARCH- AND- INFORMATION
COMING IN EVEN AS PRESENTED TO
THIS COMMITTEE TODAY I'M YES
YES IS VERY COMMITTED TO
CONTINUING TO WORK ON THIS
POLICY. CONTINUE TO WORK WITH
PARTNERS AND STAKEHOLDERS AS WE
CONTINUE TO THAT THAT- PROPOSAL
MOVING FORWARD AND LOOK FORWARD
TO OTHERS CONVERSATIONS UP.
HAPPY TO ANSWER ANY QUESTIONS
YOU MAY HAVE. THANK YOU VERY
MUCH. MISASAGI SURE YOU VERY
MUCH IF YOU GAVE A LOT OF
INFORMATION SHORT PERIOD OF
TIME THAT THEN. I WISH I HAD
LITTLE CHECKMARK IN FRONT OF
THESE YOURSELF. SO BEAR WITH ME
HERE YOU MAY HAVE ALREADY
ANSWERED THIS BUT I DO WANT TO
ADDRESS TWO QUESTIONS I'VE
ASKED. SO THE- YOU KNOW TODAY
THE DIGITAL DIVIDE CONTINUES TO
BE TOO GREAT IMPACT IN ALL
FACETS OF LIFE INCLUDING HEALTH
CARE. THIS IS WHY IT IS
ESSENTIAL THAT THE LEGISLATURE
ADMINISTRATION CREATE
TELEHEALTH POLICIES THAT
SUPPORT CARE FOR ALL COMMUNITY
MEMBERS INCLUDING THOSE WITHOUT
RELIABLE BROADBAND A PERSONAL
TECHNOLOGY. THAT IS OUT OF
REACH FOR THEIR INCOME LEVEL.
WITH THIS IN MIND CAN THE
ADMINISTRATION EXPLAINED THE
REASONING BEHIND REMOVING AUDIO
ONLY CARE THE SYNCHRONOUS CARE
AND REMOTE PATIENT MONITORING.
SO JUST TO CLARIFY THE
DEPARTMENT IS PROPOSING THAT WE
WOULD PAY FOR AS WE DO TODAY
SYNCHRONOUS ASYNCHRONOUS
VIRTUAL COMMUNICATION- AS WELL
AS REMOTE PATIENT MONITORING
AND TELEPHONIC AUDIO ONLY THOSE
ARE ALL CURRENTLY WITHIN OUR
PROPOSAL- AND WE ARE
RECOMMENDING TO CONTINUE THOSE.
HOWEVER I WOULD JUST WANT TO
MAKE SURE WE'RE CLEAR IN
REGARDS TO OUR PROPOSALS AROUND
WHERE WE WOULD HAVE PAYMENT
PARITY SO WE ARE RECOMMENDING
PAYMENT PARITY FOR IN PERSON
AND- SYNCHRONOUS- TELEHEALTH
MODALITIES AND WE ARE
RECOMMENDING A DIFFERENT FEE
SCHEDULE- FOR ASYNCHRONOUS. OR
TELEPHONIC AUDIO ONLY FOR
PERSONAL COMMUNICATION AND FOR
REMOTE PATIENT MONITORING SO WE
ARE ALLOWING THOSE OF THE
BENEFITS THOSE ARE PROPOSED IN
OUR PROPOSAL- HOWEVER WE ARE
RECOMMENDING- AS THE VARIATION
IN THE PAYMENT PARITY THE ONE
EXCEPTION TO THAT IS THE
TELEPHONIC AUDIO ONLY FOR FQHCS
AND RURAL HEALTH CLINICS. GIVEN
SOME OF THE COMPLEXITY
COMPLICATED KIND OF FEDERAL
RULES AROUND HOW WE PAY OF
THOSE INDIVIDUALS AND WHERE WE
ARE REQUIRED TO PAY PARITY AT.
I AM SITTING HERE THINKING
WE'RE GOING TO ADD ANOTHER
DIFFICULTY YOU KNOW WE'RE GOING
TO. IF YOU'RE THIS YOU CAN DO
THIS I JUST FEEL LIKE IT CAN WE
JUST MAKE THIS REAL SIMPLE AND
GET PEOPLE PAID BUT ANYWAY I
CLEAN. YOUR IT'S YOUR JOB NOT
MY JOB. AND UNDER THE PUBLIC
HEALTH EMERGENCY THE STATE
SHOULD BE COMMENDED FOR
RESPONDING QUICKLY TO GUARANTEE
NEXUS- CONTINUED UNDER
EXTRAORDINARY CONDITIONS AND I
WANT TO THANK YOU ALL. HOWEVER
THIS PROPOSAL CREATES A NEW
DIVIDE WITHIN MEDIC CL- THAT
WILL DISPROPORTIONATELY IMPACT
COMMUNITIES TO GET THEIR CARE
THROUGH FQHCS IN THE
MINISTRATION DRESSED THE
CONCERNS OF INEQUITY. THERE
WILL BE CREATED BY REMOVING
TELEPHONIC CARE BUT WE'RE NOT
DOING IT RIGHT. I WAS SO POOR
AT UACS THAT IS THE ONE
EXCEPTION THAT I WAS MENTIONING
AND- WE HAD CONVERSATIONS WITH
THE M. S. N. B. GIVEN OUR
RECOMMENDATION ON PAYMENT
PARITY FOR THESE SERVICES. WE
WOULD BE REQUIRED TO PAY FQHCS-
AT PAYMENT PARITY FOR A
TELEPHONIC AUDIO ONLY VISIT
WHEN BUILT. A BY A BILLABLE
PROVIDER- IN GIVEN THE AVERAGE-
REIMBURSEMENT FOR FQHC THERE'S
ABOUT TWO HUNDRED FIFTY DOLLARS
PER VISIT. I'M IN THERE ISN'T
SUBSTANTIAL RESEARCH IN REGARDS
TO YOU- OUTCOME AS WELL AS- YOU
KNOW WE ARE STRONGLY
RECOMMENDING FROM A PAYMENT
PARITY IN A PAYMENT
APPROPRIATENESS. ON THE DAY NOT
BE PAID AT THE SAME RATE THAT'S
WHY WE DID NOT PUT THAT FORWARD
IN OUR RECOMMENDATION. OKAY
THANK YOU. OKAY THANK YOU IT'S-
IT'S RARE THAT I DON'T HAVE A
QUESTION BECAUSE YOU WERE VERY
THOROUGH MISS COOPER. IN AND
YOU ANTICIPATED A LOT OF A LOT
OF THE THINGS THAT I- I HAD AN
INTEREST IN SO- J. RICHARD VERY
MUCH THE THOUGHT YOU'VE GIVEN
THIS AND- THE PRESENTATION
TODAY. AND THANK YOU AND TO
ALSO THANK YOU TO DIRECTOR LIKE
FORM MUCH APPRECIATED. THANK
YOU FOR PLEASURE. OKAY I JUST
WANT TO SAY AT THIS POINT I
WANT TO THANK OUR WITNESSES FOR
THEIR PRESENTATIONS- BEFORE WE
GO TO THE PHONE LINES FOR
PUBLIC COMMENT I'D LIKE TO MAKE
A FEW COMMENTS BUT I'D LIKE TO
GIVE ASSEMBLY MEMBER KERR
AGUIAR-CURRY AN OPPORTUNITY TO
DO SO BEFORE RIGHT NOW. OKAY
OKAY- FIRST OF ALL I THINK WE
WOULDN'T NEED TO HAVE A
DISCUSSION OVER OVER THE
PAYMENT PARITY FOR TELEPHONE
TELEPHONE VISITS REF CASEY'S IF
WE HAD AN ALTERNATIVE PAYMENT
MODE METHODOLOGY- WE NEED. WE
NEED A SMALL SPACE WEAKENED
STATE LAW BUT IT SOUNDS LIKE WE
ALSO NEED TO TWEAK IN FEDERAL
LAW. TO ALLOW THIS TO HAPPEN-
YOU KNOW WE COULD CLINICS COULD
PROVIDE SAME DAY VISIT
TELEPHONE TELEPHONE TELEHEALTH
VISITS AND USE DIFFERENT TYPES
OF NON BILLABLE PROVIDERS. ALL
OF THIS COULD OCCUR IF WE HAD
AN ALTERNATIVE PAYMENT
METHODOLOGY. BUT THE STATE
ASSOCIATION IS OPPOSED. TO
MAKING THAT TWEAK SO HERE WE
ARE SO IF YOU'RE UNHAPPY THAT
YOU CAN'T PROVIDE A TELEPHONE
SERVICES POST A PUBLIC HEALTH
EMERGENCY. UNDER WHAT THE
DEPARTMENT'S PROPOSING I THINK
WE NEED TO LOOK IN THE MIRROR.
AS TO WHY IT'S HAPPENING RIGHT
ISN'T HAPPENING. WE HAD A
CHANGE STATE LAW TO AUTHORIZE
AN ALTERNATE PAYMENT
METHODOLOGY IN TWENTY FIFTEEN
IT NEEDS A SMALL TWEAK TO GET
CMS APPROVAL. BUT IT NEVER
SEEMS THE RIGHT YEAR. TO
APPROACH AND REVISIT THE EIGHT
PM DISCUSSION. INSTEAD WE KEEP
BUILDING OFF OF WHAT I THINK IS
A FLAWED PAYMENT MODEL- THE PPS
RATES OF THE STATE PAYS FQHCS
RATING FROM. SIXTY THREE
DOLLARS AND SIXTY NINE CENTS A
VISIT. TO SEVEN HUNDRED AND
EIGHTEEN DOLLARS AND SIXTY
SEVEN CENTS A VISIT. THAT'S
MORE THAN A MONTH THE PAINT IN
THE MONTHLY PAYMENT THE STATE
MAKES TO PLANS FOR ADULTS AND
KIDS I DON'T THINK A PAYMENT
RANGE THAT WIDE MAKES SENSE.
NOW WE'RE BEING ASKED TO EXTEND
THAT FLOOD PAYMENT MODEL TO
TELEPHONE CALLS I SERIOUSLY
QUESTION WHETHER AN AVERAGE P.
P. S. RATE OF TWO HUNDRED AND
FOURTEEN DOLLARS AND SIXTY
CENTS. AND A MEDIAN RATE OF TWO
HUNDRED AND THREE DOLLARS AND
ONE CENT IS APPROPRIATE FOR A
TELEPHONE CALL. WHEN PRIVATE
VENDORS DO IT FOR UNDER FIFTY
DOLLARS- SECOND ON THE ISSUE OF
PAYMENT PARITY FOR PRIVATE
HEALTH PLANS I REALIZE I VOTED
FOR THE TELEPHONE. TELL TELL
HEALTH- PAYMENT. YEAH THIS IS
MADE TOTAL PAY A PAYMENT PARITY
BILL. LET'S CALL IT PAYMENT
PARITY THIS CALL PAYMENT PARITY
WHAT IT YES PAYMENT PARITY
UNDER ANY OTHER NAME IS RATE
SETTING. WHEN I WORKED ON
SURPRISE BUILDING A BILLING- IN
TWO THOUSAND AND SIXTEEN I
HEARDOVER AND OVER. WHY SHOULD
THE GOVERNMENT SET COMMERCIAL
RATES. NOW WE HAVE THOSE SAME
PEOPLE ARGUING THAT THAT STATE
ARGUING STATE LAW SHOULD SET
MINIMUM RATES BECAUSE IT'S IN
THEIR FINANCIAL INTERESTS. SO
IS A LEVEL OF HYPOCRISY THERE
THAT BOTHERS ME PARTICULARLY
WHEN AMERICANS SPEND FAR MORE
ON HEALTHCARE THAN ANYONE ELSE
IN THE WORLD. AND ANY EFFORTS
TO DO SOMETHING ABOUT IT IS
CHARACTERIZED AS OUT OF BOUNDS-
WITH THAT- WILL OPEN THE LINES
TO PUBLIC COMMENT- WE ASK
MEMBERS OF THE PUBLIC TO KEEP
THEIR COMMENTS TO TWO MINUTES
OR LESS- WE ALSO A WILL AND CAN
ACCEPT WRITTEN COMMENTS THAT
ARE SUBMITTED TO THE COMMITTEE-
OPERATOR- I'M GONNA SAY THE
NAME. THE NUMBER ONCE AGAIN SO
PEOPLE WHO HAVE. WANT TO COLIN
CAN. IT SHOULD BE ON THE
SCREEN. BUT I'LL SAY IT AGAIN
FOR AND FOR ANYONE. UP THERE
WHO'S LISTENING- THE NUMBER FOR
CALLING IS EIGHT SEVEN SEVEN.
SIX NINE TWO. EIGHT NINE FIVE
SEVEN. THE ACCESS CODE IS. TWO
FOUR TWO SIX TWO THREE SEVEN
ONCE AGAIN THAT'S EIGHT SEVEN
SEVEN SIX NINE TWO. EIGHT NINE
FIVE SEVEN AND THE ACCESS CODE
IS TWO FOUR TWO SIX TWO THREE
SEVEN- OPERATOR- WILL GIVE ME A
MINUTE BUT IF THERE'S ANYONE ON
THE LINE IS ONE WHO WANTED TO
GET PUBLIC COMMENT PLEASE
PLEASE GO AHEAD. ALL RIGHT
THANK YOU LADIES AND GENTLEMEN
IF YOU WISH TO SHARE A COMMENT
PLEASE PRESS ONE THEN ZERO ON
YOUR TELEPHONE KEYPAD YOU MAY
WITHDRAW YOUR COMMENT AT ANY
TIME BY REPEATING THE ONE ZERO
MATT. IF YOU ARE USING A
SPEAKER PHONE BECAUSE THE
HANDSET BEFORE PRESSING THE
NUMBERS ONCE AGAIN IF YOU'D
LIKE TO SHARE A COMMENT PLEASE
PRESS ONE THEN ZERO. AT THIS
TIME. AND OUR FIRST QUESTION
COMES FROM LINE EIGHTEEN LINE
EIGHTEEN. WAIT PLEASE STATE
YOUR NAME AND AFFILIATION.
THANK CHAIR RYAN SPENCER ON
BEHALF OF THE OCEAN AND THE
CALIFORNIA TELEHEALTH NETWORK.
WHICH IS NETWORK OF
COMMUNICANTS AND BECAUSE THIRTY
TO HELP BRING MEMBERS. OF
NEARLY ONE POINT FIVE MILLION
NETWORK PATIENTS HALF OF THOSE
RECEIVING CARE UNDER MEDICARE.
AND TWENTY TWENTY ORGANIZATIONS
IT'S AN OCEAN NETWORK RECEIVED
TWO POINT EIGHT MILLION UNIQUE
VISITS TO CALIFORNIA. AND
RESULT OF THE CELTICS FANS INTO
202037% OF THOSE ENCOUNTERS
WERE CONDUCTED USING
TELEHEALTH. THE MOST MAJORITY
WHICH WERE PRIMARY CARE
SERVICES- JIM STRONGLY SUPPORTS
CONTINUING THE TELEHEALTH LIKE
ABILITIES PARTICULARLY ENSURING
PAYMENT PARITY AS DETAILED. IN
A SEVEN MEMBER AGUILAR CURRY'S
AB THIRTY TWO PARTICULAR
CRUCIAL IT'S PARODY FOR AUDIO
ONLY APPOINTMENT SINCE ABOUT
26% OF OCEANS TELEVISIONS WERE
AUDIO ONLY. MOST OF WHICH FOR
BEHAVIORAL SERVICES
ADDITIONALLY 36% OF AUDIO ONLY
ACCOUNTED FOR WITH PATIENTS
BEST SERVED IN A LANGUAGE OTHER
THAN ENGLISH. AND WITHIN OCEAN
NETWORK PATIENTS LACKING
TRANSPORTATION WERE ALMOST
THREE TIMES AS LIKELY TO HAVE
AN IDEA ONLY VISITS AND THOSE
WITH. NHL CONTINUATION OF
PARITY AND EXPANDED TELECOM
WHICH IS ESSENTIAL IN ACCESS TO
CARE FOR HIGH RISK AND WILL
PATIENTS ABOUT THE STATE. AND
HELP MANY OTHERS OVERCOME.
COMMON HEALTH CARE BARRIERS.
YOUR TIME TODAY THANK YOU FOR
THIS GREAT. THANK YOU FOR MUCH
THE NEXT PLEASE. THANK YOU
THAT'S WHY THIRTY. LINE
THIRTEEN PLEASE GO AHEAD. AND
THIRTEEN YOUR LINE IS OPEN IS
YOUR PHONE ON MUTE. WILL MOVE
ALONG TO LINE. THIRTY SIX
THIRTY SIX. HELLO CAN YOU HEAR
ME. YES THANK YOU GREAT THANK
YOU- DEAR MEMBERS OF THE
ASSEMBLY HEALTH COMMITTEE MY
NAME IS MAX COURY I AM THE
DIRECTOR OF COMMUNICATIONS AND
PUBLIC AFFAIRS FOR THE REDWOOD
COMMUNITY HEALTH COALITION OR A
CONSORTIUM OF SIXTEEN COMMUNITY
HEALTH CENTERS BUT TWENTY SEVEN
SITES IN CINEMA MARIN NAPA AND
YOLO COUNTIES SERVING TWO
HUNDRED AND THIRTY THREE
THOUSAND PATIENTS EACH YEAR- IN
TWENTY TWENTY. AT THE STATE'S
DECISION TO TEMPORARY LIFT
RESTRICTIONS ON TELEHEALTH
DELIVERY HAS BEEN A GAME
CHANGER. IT'S FACILITATED IN
INNOVATION AT THE LOCAL
COMMUNITY HEALTH CENTER LEVEL.
BY ALLOWING OUR MEMBER HEALTH
CENTERS TO PROVIDE A BILL TPS.
FOR BOTH VIDEO AND AUDIO
BUSINESS. HAS ALLOWED US TO
REACH MORE PATIENTS WITH
QUALITY SERVICE WHERE THEY ARE.
OUR DATA SHOWS THAT BETWEEN
MARCH FIRST TWENTY TWENTY. AND
FEBRUARY FIFTEENTH TWENTY
TWENTY ONE. 62% OF VISITS TO
OUR MEMBER HEALTH CENTERS
PROVIDE TELEHEALTH WITH A 57%
CHOOSING PHONE VISITS AND 5% BY
VIDEO. IT'S IMPERATIVE THAT WE
CONTINUE TO ALLOW TELEHEALTH
INCLUDING AUDIO VISITS FOR
PATIENTS POST CODE. WE ARE
PLEASED TO SEE THAT T. H. THE
ACTORS FULLY ON BOARD WITH
TELEHEALTH BEEN A PERMANENT
FIXTURE OF THE HEALTH CARE
SYSTEM POST CODE BUT- GIVEN
THAT MANY VULNERABLE PATIENTS
DO NOT HAVE THE COMFORT OR
ABILITY TO DO VIDEO CALLS. IT'S
CRITICAL THAT TO RECEIVE THE
NECESSARY CARE THAT THEY NEED
THAT HEALTH CENTERS CONTINUE TO
BE ABLE TO PROVIDE TELEPHONE
VISITS AS WELL AS VIDEO AND
THAT THE SYSTEM PAYS FOR SUCH
VISITS. THANK YOU SO MUCH FOR
ALL YOUR WORK DURING KOBE TO
KEEP OUR COMMUNITY SAFE AND FOR
THE OPPORTUNITY TO SHARE OUR
PERSPECTIVE OF HEALTH CENTERS
HERE TODAY. THANK YOU. THANK
YOU VERY MUCH. NEXT CALLER.
THANK THANK YOU AND THAT COMES
FROM LINE THIRTY FOUR LINE
THIRTY FOUR PLEASE GO AHEAD.
YOU HI MY NAME IS CAPTAIN
MONTGOMERY. I'M CALLING IN AND
SHARING STATEMENTS ON BEHALF OF
PLANNED PARENTHOOD MAR MONTE
POSITION. LOCATED IN REDWOOD
CITY AND WALKED IN THE BILL.
FROM WHAT REDWOOD CITY OUR
POSITION ROAD I HAVE A PATIENT
WHO IS SOBER NOW AFTER MANY
YEARS AND LIVING WITH HER OLDER
PARENTS HER SON AND
GRANDCHILDREN. THERE ARE A
NUMBER OF PSYCHOSOCIAL
STRESSORS IN HER LIFE AND IT'S
CRUCIAL TO HER CARE THAT WE
HAVE FREQUENT VISITS. THE
MANAGER MENTAL HEALTH AND
MAINTAINING HER SOBRIETY. SHE
HELPED HER GRAND CHILDREN WOULD
JUST ENQUIRING BUT SHE IS ALSO
WORKING PART TIME SO- HAVING
THE FLEXIBILITY OF A SCHEDULE
TWENTY MINUTE VISIT AND
SOMEBODY A STEP HAVING TO TAKE
A MINIMUM OF ONE AND A HALF
HOURS. THE COMMITTEE NAY IN THE
CLINIC HAS GIVEN HER ACCESS. TO
CARE THAT SHE OTHERWISE WOULD
NOT HAVE. A SHE RECENT HAD CO
THAT. AND WE WERE A TO HAVE
SEVERAL TELEHEALTH. TO MONITOR
HER COPE WITH SYMPTOMS. AT THE
ANXIETY SHE WAS EXPERIENCING
DURING THE TIME FROM- THE
SAFETY OF HER HOTEL ROOM. FROM
OUR DOCTOR AND WHAT NOW SHE
WROTE TELEHEALTH A LOT BY
PATIENTS WHO ARE FARMWORKERS
THE ABILITY TO ACCESS HEALTH
CARE. WITHOUT HAVING TO TAKE
TIME OFF OF WORK TO DO SO. MANY
OF MY PATIENTS ARE SCHEDULING
VISITS DURING THEIR LUNCH BREAK
TIME. THIS IS ALSO ALLOWED ME
TO CONNECT WITH MORE PEOPLE
THAT I PREVIOUSLY HAD BUT ALL
THIS IT'S WERE CONDUCTED IN THE
OFFICE. MANY OF THE PATIENTS
CAREFUL CANNOT GO TO THE CLINIC
DUE TO LACK OF TRANSPORTATION.
AND TELEHEALTH IS REMOVED-
EVERYONE THOUGHT THAT THAT. TO
CONTINUE WITH PAYMENT THANK YOU.
THANK YOU VERY MUCH. NEXT
CALLER PLEASE. AND THAT COMES
FROM ONE THIRTY EIGHT PLEASE GO
AHEAD. GOOD AFTERNOON CHEN
MEMBERS LINDA WAY WITH
RESTAURANTS AND- ON POVERTY HE
SUPPORT THE EXPANSION OF
TELEHEALTH IN A WAY THAT HONORS
CONSUMER CHOICE IN WHETHER TO
USE TELEHEALTH IN WHICH
TELEHEALTH TECHNOLOGIES TO USE
CREATING TELEPHONE VIDEO-
ANTHONY. CRITICAL TO ENSURING
QUALITY STANDARDS OF CARE THAT
WILL NEED TO BE FURTHER
DEVELOPED IN ADDITION LANGUAGE
ACCESS OR YOU CAN PUT TO
RECOMMEND DIFFERENT MODALITIES
BE ALLOWED TO LOCATE PUTTING
WHICH TRANSLATION IF REQUESTED.
WE HAD CONCERNS REGARDING THE
DEPARTMENT'S TDL KICKS IN THE
USE OF ALTERNATIVE ACTIVE
STANDARD TWO THREE YEARS
INSTEAD OF ANNUALLY
DISABILITIES PLAN THAT
RESPONSIBILITIES TO MANDATE IT
KIND OF DEFEATS SANDERS FOR TOO
LONG. AND WE CAN GET WORK
ADEQUATELY PLAN FOR ALLOWED TO
USE WITH YOUR STANDARD FOR
THREE INSTEAD OF ONE YEAR THE
ADDITION OF TEL HELP SHOULD NOT
BE A REASON TO WEAKENED
PHYSICALLY.CONSUMER PROTECTION
THANK YOU. THANK VERY MUCH-
NEXT CALLER TO. AND THAT'S LINE
FOUR PLEASE AHEAD. BUT
AFTERNOON CHAIRMAN MEMBERS
CLIENTELE CAUGHT ON BEHALF THE
CALIFORNIA COUNTY BEHAVIORAL
HEALTH DIRECTORS ASSOCIATION
WANT TO THANK YOU TODAY FOR
THAT DISCUSSION ON TELEHEALTH
OVER THE PAST YEAR COUNTY
BEHAVIORAL HEALTH PLANS HAVE
WORK TO PROVIDE SAFE FACE TO
FACE MENTAL HEALTH AND
SUBSTANCE USE SERVICES. ALSO
OFFERS FLEXIBLE VIDEO PHONE
BASED SERVICES OKAY FOR
TELEHEALTH IT'S CLINICALLY
APPROPRIATE AND DESIRABLE TO
THE CLIENT AND ACCEPTABLE. THE
PANDEMIC HAS CONFIRMED THAT THE
DIGITAL DIVIDE IN CALIFORNIA
GRILL AND PERSISTENT MANY MEDIC
CAL CLIENTS LACK RELIABLE
ACCESS TO BROADBAND. AND VIDEO
TECHNOLOGY. BECAUSE OF THESE
GAP COMMITTED ACCESS MANY
COUNTY HEALTH CLIENTS CURRENTLY
RELY ON PHONE CALLS TO MAINTAIN
CONTACT WITH THEIR PROVIDERS
WILL WANT TO HIGHLIGHT THE NEED
FOR PAYMENT PARITY FOR PHONE
BASED BEHAVIOR HELP THERE BUT
THAT GOING FORWARD. ONLY ABLE
SERVICE ARE NOT AFFECTED FOR
FACE TO FACE CONTACT BETWEEN
PROVIDERS WILL CLIENTS INSTEAD
THEY ARE VALUABLE COMPLEMENT.
ONLY THIRTY SESSION HAVE LONG
BEEN USED BY THERAPISTS
ALONGSIDE WITH OTHER PRACTICES
WE DON'T WANT TO BE BEHAVIORAL
HEALTH PROVIDERS DISCOURAGED
FROM OPPOSITE FROM OFFERING
THAT OPTION IN THE FUTURE DUE
TO LACK OF APPROPRIATE
INCORRECTLY. IDENTIFIED PROBATE
VISIT COULD FURTHER
DISADVANTAGED COMMUNITIES OF
COLOR. CORRECT PERPETRATE.
ACTUATING HELPED. WE APPRECIATE
THE TO BRING- THE NEED FOR
PHONE PAYMENT PARITY TO THE
COMMITTEES ATTENTION IT'S GOT
TO COME WITH THE H. ONLY LOOK
FOR. TO ON CONTROVERSY WITH
STAKEHOLDERS THANK YOU. THANK
YOU VERY MUCH. NEXT NEXT CALLER
PLEASE. AND THAT COMES TO MIND
FIFTY SEVEN PLEASE GO AHEAD.
CAN BE HILLARY REPRESENTING THE
CALIFORNIA MEDICAL ASSOCIATION.
INNING OF THE COVERT NINETEEN
PANDEMIC CMA WORKED WITH THE
STATE OF CALIFORNIA KAREN HOW
HEALTH SERVICES WOULD BE
AVAILABLE TO PATIENTS IN NEED
AT PMI URGES YOU TO CONSIDER
HOW WE CEMENT AND BUILT ON THE
FACT THAT THE LAST YEAR AND
RESIST THE TEMPTATION TO RETURN
SPREE PANDEMIC STRATEGIES FOR
TELEHEALTH. TO THAT END YEAH MY
MUST RAISE CONCERN ABOUT EACH
YEAR HELLO HELP PROPOSAL WHICH
SUGGESTS THAT PAIN FOR
TELEPHONE AUDIO ONLY VISIT WILL
RECEIVE REIMBURSEMENT AT
SEPARATE LOWER FEES GOT FALL
THIS FACET OF THE PROPOSAL IF
ENACTED WILL CREATE A SERIOUS
IMPEDIMENT ACCESS TO CARE FOR
UNDERSERVED POPULATION. ONE OF
THE THINGS THE KOPET NINETEEN
PANDEMIC IT HIGHLIGHTED IT BUT
THAT AND WEBER BUT THE DIGITAL
DIVIDE EVEN HERE IN TECH SAVVY
CALIFORNIA OLDER PATIENTS THAT
FIRST COMMUNITIES GROW AREA AND
OTHER UNDERSERVED POPULATION
ALL STRUGGLE WITH ACCESS THE
BROADBAND INTERNET. WHILE THE
STATE CONTINUES TO WORK ON
BRIDGING THAT DIVIDE THE
TELEPHONE WILL CONTINUE TO BE
AN ESSENTIAL COMPONENT OF
ACCESS TO CARE FOR THOSE
STRUGGLING WITH ACCESS TO
TECHNOLOGY TREATING TELEPHONE
VISIT AT TECHNICAL RATE WILL
ONLY SERVE TO DEEPEN THE
INEQUALITIES THAT ALREADY
PLAGUE OUR HEALTH CARE SYSTEM
WE URGE THE LEGISLATURE TO
REJECT ANY PROPOSAL THAT TREAT
TELEPHONE THAT THAT DIFFERENTLY
FROM VIDEOCASSETTE. THANK YOU
SO MUCH FOR HAVING. THE HEARING
AND ALLOWING ME. THANK YOU VERY
MUCH NICK CALLER. AND THAT
COMES TO MY THIRTY LINE
THIRTEEN PLEASE GO AHEAD. HI MY
NAME THANK YOU ASSEMBLY MEMBER
WHAT AND OTHER MEMBERS OF THE
ASSEMBLY HEALTH COMMITTEE MY
NAME IS BY AFGHAN AND I'M
CALLING TODAY ON BEHALF OF
NORTH COUNTY HEALTH PROJECT
EIGHT- ALSO KNOWN AS TRUE CARE.
WE ARE LOCATED IN SAN DIEGO AND
RIVERSIDE COUNTY AND WE
CURRENTLY SERVE APPROXIMATELY
FIFTY SIX THOUSAND PATIENTS AND
HAVE ELEVEN CLINICS ACROSS THE
TWO COUNTIES MENTIONED- TRUE
CARE IS A STRONG SUPPORTER OF
EXPANDING TELEHEALTH INCLUDING
TELEPHONIC CARE POST THE CODE
NINETEEN ENDEMIC. WE HAVE BEEN
LEVERAGING TELEHEALTH
TECHNOLOGY TO IMPROVE ACCESS TO
CARE AND MEET INCREASING
PATIENT DEMAND. PRIOR TO THE
PANDEMIC WE ARE UTILIZING
TELEHEALTH TO OVERCOME PHYSICAL
CAPACITY LIMITATIONS AND A
FIFTEEN THIRTY- ECONOMIC
BARRIERS THAT PREVENTED
PATIENTS FROM ACCESSING. CARE
AT OUR HELP CENTER. DURING THE
CALL THE NINE TEN. WE EXPAND
TELEHEALTH TAKEN TO OVER THAT
THERE'S A CONTACT LIMITATIONS
AND SOCIO ECONOMIC BARRIERS. IN
OTHER WORDS ALL OF THE PANDEMIC
YOU PROVIDE SAFE AND RAPID
ACCESS TO HEALTH CARE SERVICES
DURING THE MUCH NEEDED PACKING.
THANK MARCH 25% OF OUR
PROVIDERS HAVE CONDUCTED
TELEPHONE TELEPHONIC VISIT. AND
90% OF PROVIDERS HAVE BEEN
CHANGED THE NEW HOME AND HAVE
CONDUCTED BY GOOD FOR PRIMARY
CARE BEHAVIORAL HEALTH AND OR
WOMEN'S HEALTH FOR
APPROXIMATELY THIRTY ONE
THOUSAND PATIENTS. ARE THE
RESULT OF IMPLEMENTING
TELEHEALTH IN CALIFORNIA CARE
BEHAVIORAL HEALTH VISITS GREW.
A HUNDRED AND 20% GREENHOUSE
ARE PROVING THAT TELEHEALTH
INCLUDING TELEPHONIC CARE IS
NOT ONLY SAFE AND EFFECTIVE BUT
IT ALSO SOLUTION KIDNAPPINGS OF
THE- ECONOMIC BARRIERS AND
AFRICAN CARE AS WELL AS REDUCE.
THE NO SHOW RATE SIGNIFICANTLY.
SHOULD THE PROPOSAL GET PASSIVE
CURRENT FORM AND WILL MAKE LIKE
TAKING INTO ACCOUNT BLACK
INDIGENOUS AND OTHER
COMMUNITIES OF COLOR. AND THOSE
WHO DON'T HAVE ACCESS TO
INTERNET. THANK YOU FOR YOUR
TIME AND CONSIDERATION AND THE
POOR OF ST HEALTH CENTER. THANK
YOU VERY MUCH NEXT CALL PLEASE.
AND THAT COMES ONE TWENTY EIGHT
PLEASE GO AHEAD. THANK YOU MY
NAME IS MARTY A MODEM A FAMILY
MEMBER TO INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES COME
OFF ON THE DEVELOPMENTAL
SERVICES PASSPORTS AND ON THE
MASTER PLAN BREAKING
SUBCOMMITTEES ON SAID ADVISORY
COMMITTEE ANOTHER STAKEHOLDER
GROUPS PRESS ONE TO SAY THE
FEELING IS BEEN VERY GOOD AND
VERY HELPFUL FOR EVERYONE PER
PROVIDERS FOR. FAMILY MEMBERS
PEOPLE WITH DISABILITIES AND
POLICY MAKERS- I APPRECIATE
VERY MUCH THE ISSUES RAISED OF
HIGH VALUE SERVICES OF EQUITY
OF PARITY AND DISPARITIES NOT
JUST REGARDING COMMUNITIES OF
COLOR OF WHICH I'M A PART OF
BUT ALSO ISSUES OF GEOGRAPHY
AND ECONOMIC STATUS. WHICH
OBVIOUSLY YOU'VE ALWAYS
CONSTANTLY- MENTIONED- IN
CHAMPION MR WOULD APPRECIATE
ALL THE PANELISTS ALL GOOD
ESPECIALLY DR THE. NEW THE NEW
NAY. PRESENTATION FOR IN BOTH
COMMITTEE. THESE ISSUES SYSTEM
LINE ARE CRITICAL AND URGENT
INCLUDING THOSE IN EARLY START
THAT FOR INFANTS AND TODDLERS
AND EARLY INTERVENTION.
REGIONAL TENNIS SERVICES FOR
PEOPLE WITH DEVELOPMENTAL
DISABILITIES. HEALTHCARE
SERVICES FOR PEOPLE WITH
DISABILITIES MENTAL HEALTH
NEEDS SINGERS AND THEIR
FAMILIES. DETAILING ALL THIS
CRITICAL EXPANDING CARE BUT
RIGHTLY THIS COMMITTEE IS
LOOKING AT THE ISSUES OF
EQUITY. AND DISPARITIES- AND-
THIS HEARING HAS REALLY
ADVANCED THE BILL YOU KNOW
LOOKING AT SOLUTIONS IN INDIA
AND THE NEED TO WORK TOGETHER
AND SO WE APPRECIATE THAT ALSO
JUST WANT TO SAY FROM PERSON
WHO. DOESN'T HAVE GOOD HEALTH
CARE THAT WHEN I HAD COLLUDED-
LAST YEAR IN MARCH BEFORE WE
CAN HAVE ACCESS TO HEALTH CARE
OR TRANSPORTATION AND SO THE
ISSUE THAT YOU HAVE TALKED
ABOUT TODAY ARE REALLY
COMPELLING TO ME ON A PERSONAL
LEVEL. AND LASTLY JUST WANTED
TO A SHOT OF. MY APPRECIATION
TO WILL LIKE MORTGAGE RATES
COOPER IN THE TEAM THEIR IT
DEPARTMENT HEALTHCARE SERVICES
THEY'VE BEEN REALLY GOOD
PARTNERS- IN WORKING TOGETHER.
THANK YOU. THANK YOU FOR MUCH-
NEXT NEXT CALLER. AND THAT
COMES ALIVE FORTY EIGHT LINE
FORTY EIGHT PLEASE GO AHEAD-
GOOD AFTERNOON CHAIRMAN GO TO
MEMBERS OF THE COMMITTEE GEN
HAMPER THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS
REPRESENTING FORTY FIVE
ORGANIZATIONS THAT COLLECTIVELY
DELIVER HEALTHCARE COVERAGE TO
APPROXIMATELY TWENTY SEVEN
MILLION CALIFORNIANS. THANK YOU
SO MUCH FOR THE OPPORTUNITY BY
PUBLIC COMMENT ON TODAY'S
HEARING. I CAP IS GENERALLY
SUPPORTIVE OF EXTENDING MANY OF
THE TELEHEALTH FLEXIBILITY THAT
HAVE BEEN IMPLEMENTED CAN BE
INNING AT THE PUBLIC HEALTH
EMERGENCY. HEALTH PLANS THAT
PLAYED A KEY ROLE IN MAKING
TELEHEALTH WILL COME MORE
CALIFORNIANS WHICH IS HELP BOTH
OUR PATIENTS AND PROVIDERS
ALIKE. A DIFFICULT ARE EFFORTS
TO BOLSTER TELEHEALTH
UTILIZATION BY PROVIDING
HEALTHCARE PROVIDERS IN THE
MOST UNDERSERVED PARTS AND
STATE WITH MILLIONS OF DOLLARS
IN GRANTS AND FINANCIAL
ASSISTANCE FOR TELEHEALTH
STARTUP COSTS. BY UTILIZING
INTERACTIVE VIDEO CONFERENCING
TO PROVIDE HIGH SPEED ACCESS TO
SPECIAL CARE FOR MEMBERS ACROSS
THE STATE. IN PARTNERING WITH
VENDORS AND NONPROFIT
ORGANIZATION TO EXPAND OUR
TELEHEALTH. APRIL OFFERING. I
WE DO SHARE MANY OF THE SAME.
THAT CONCERN AROUND FULL
PAYMENT FOR TELL ONLY VISIT.
NEVER ARE. ANYTHING HOWEVER WE
DO OKAY ONLY HELP THIS- OVERALL
EFFORT WILL BUILD ON THE
PROGRESS MAY. IN THE LAST SEVEN
MONTHS. I WOULD LOOK FOR TO BE
A PART OF THE- WITH THE LATEST
IN MYSTERY MOVIE. THANK YOU.
THANK YOU VERY MUCH NEXT CALLER
PLEASE. THANK YOU AND THAT
COMES TO MIND FIFTY THREE. GOOD
AFTERNOON CHAIRMAN LLOYD AND
MEMBERS OF THE COMMITTEE MY
NAME IS TERRA HAPTICS AND I'M
THE SENIOR VICE PRESIDENT FOR
EXTERNAL AFFAIRS AT THE
CALIFORNIA ASSOCIATION OF
PUBLIC HOSPITALS AND HEALTH
SYSTEMS THANK YOU FOR PUTTING
THE SENATE HEARING TOGETHER ON
SUCH AN IMPORTANT TOPIC HE
TEACH REPRESENTS TWENTY ONE
PUBLIC HEALTH CARE SYSTEMS THAT
INCLUDE COUNTY OWNED AND
OPERATED OR AFFILIATED. SYSTEMS
AND THE FIVE UNIVERSITY OF
CALIFORNIA MEDICAL CENTERS THE
MAJORITY OF THE PATIENTS THAT
WE SERVE ARE COVERED BY
MEDICARE INSURED AND MANY R.
RANCHO WORKERS IMMIGRANTS FOR
UNDER OTHER VULNERABLE
POPULATIONS THAT HAVE BEEN
DISPROPORTIONATELY IMPACTED BY
CO THAT NINETEEN. OUR
COMMITMENT AND TO AND TO ENROLL
IN SERVING THIS LARGELY LOW
INCOME PATIENT POPULATION HAS
NEVER. BEEN MORE IMPORTANT THAN
IT IS TODAY. HOW HAS BEEN.
ESSENTIAL AND OUR SYSTEM
CONNECTED WITH THEIR PATIENTS
FOR MANY OF OUR SYSTEMS ROUGHLY
2250% OF PRIMARY CARE AND
SPECIALTY CARE VISITS CONTINUE
TO BE VIRTUAL. AND FOR MANY OF
OUR SYSTEMS THE VAST MAJORITY
OF THESE VISITS ARE OVER THE
PHONE. SOME EXAMPLES OF THE
TYPES OF VISITS THAT ARE
ESPECIALLY HELPFUL- VIRTUALLY
INCLUDE CHANGING MEDICATIONS
ADDRESSING CHRONIC DISEASE
MANAGEMENT CONCERNS. DISCUSSION
DISCUSSING PAIN MANAGEMENT AND
BEHAVIOR HOW. ARE MEMBERS OF
SHARED A NUMBER OF IMPORTANT
BENEFITS THAT HAVE RESULTED
FROM EXPANDED TELEHEALTH
INCLUDING A GREATER NUMBER OF
PATIENTS BEING ABLE TO MAKE
THEIR APPOINTMENT. ABILITY TO
CONNECT WITH PATIENTS THAT
MIGHT NOT OTHERWISE HAVE BEEN
ABLE TO COME INTO THE CLINIC-
FOR AN IN PERSON VISIT AND MANY
OTHERS. PHONE IN PARTICULAR IS
A CRITICAL MODALITY FOR OUR
PATIENTS AND WILL CONTINUE TO
BE LONG AFTER THE PANDEMIC
OVER. THEY CAN PHONE BUSINESS
CAN BE A GOOD SUBSTITUTE FOR
CERTAIN TYPES OF IN PERSON
VISITS. AND WHEN THE SAME
STANDARDS OF CARE ARE MET WE
BELIEVE PAYMENT SHOULD BE THE
SAME AS THAT COULD HAVE BEEN IN
PERCENT. ALTHOUGH MANY OF OUR
SYSTEMS ARE WORKING TO EXPAND
VIDEO CAPABILITY ENCOURAGING
PATIENT UPTAKE REMAINS
CHALLENGING MANY OF OUR
PATIENTS PER PER THE PHONE.
BECAUSE IT'S BEEN A STRUGGLE
WITH LIMITED DATA PLANS.
INTERNET ACCESS CHALLENGES AND
LACK OF PRIVACY. SOMEONE HAS.
BEEN A CRITICAL LINKAGE TO CARE.
WE LEARNED A LOT ABOUT THE
VALUE OF TELEHEALTH OVER THE-
YEAR. AND RECOGNIZE THEIR EVEN
MORE TO LEARN AFTER THE PUBLIC
HEALTH EMERGENCY AND- WE CAN
FULLY INTEGRATE ALL OF THESE
MODALITIES WITH NO LIMIT. ON IN
PERSON THAT THAT AND IF W WORK
TOGETHER TO ADDRESS THE
CONCERNS THAT HAVE COME UP
TODAY RELATED TO PHONE. WE HOPE
TO WORK CLOSELY WITH THE
DEPARTMENT AND THE LEGISLATURE
TO CRAFT SOLUTIONS THAT HELP
ACHIEVE. MANY OF OUR SHARED
PRIORITIES AROUND MAINTAINING
AND STRENGTHENING ACCESS TO
CARE. ADVANCING OUR SHARED
GOALS RELATED TO EQUITY IN
REDUCING DISPARITIES. AND
ADVANCING STRATEGIES AND
PAYMENT MODELS THAT DEMONSTRATE
VALUE FOR THE MEDICARE PROGRAM
AND PORT AND SHERRY. I LOVE
MONITORING OUR PROGRESS SO THAT
WE CAN LEVERAGE BEST PRACTICES
AND LESSONS LEARNED. WE LOOK
FORWARD TO CONTINUE TO WORKING
WITH THIS COMMITTEE AND THE
ADMINISTRATION THANK YOU VERY
MUCH. THANK YOU VERY MCH- NEXT
CALLER PLEASE. THANK YOU AND
THAT COMES FROM LINE FIFTY
THREE PLEASE GO AHEAD FIFTY
THREE. ARE THEY DISCONNECTED
WE'LL GO TO LINE NUMBER SEVEN
LINE NUMBER SEVEN. GOOD
AFTERNOON AND THANK YOU MISTER
CHAIR AND MEMBERS OF THE
ASSEMBLY HEALTH COMMITTEE MY
NAME IS IRENE HOLGUIN CALLING
ON BEHALF OF ARROYO VISTA
FAMILY HEALTH CENTER AND IF YOU
WAIT C. LOCATED IN LOS ANGELES
CALIFORNIA. RESPECTFULLY
REQUEST AN EXPANDING TELEHEALTH
SPECIFICALLY AUDIO ONLY
TELEPHONE POLITICAL THAT
NINETEEN DANYCH. HEALTH CARE IS
SAFE EFFECTIVE PROVEN MODEL OF
CARE THAT HAS SUPPORT OF BOTH
PATIENTS AND PROVIDERS WE'RE
LOOKING FORWARD TO WORKING WITH
THE LEGISLATURE AND THE
ADMINISTRATION TO DO THE RIGHT
THING AND MAKE TELEHEALTH
FLEXIBILITY AS PERMANENT. FOR
THE HEALTH OF OUR FAMILIES OUR
COMMUNITY AND OUR STATE THANK
YOU. THANK YOU VERY MUCH NEXT
CALLER PLEASE. THANK YOU IN
THAT LINE NINETEEN. HI MY NAME
IS KAREN MOTORBIKE AND I'M
CALLING ON BEHALF OF MINUTES
FROM THE CLINIC THE COMMUNITY
HEALTH CENTERS SERVING TWENTY
THOUSAND PEOPLE IN LOS ANGELES
COUNTY. WE ARE STRONG
SUPPORTERS OF EXPANDING
TELEHEALTH INCLUDING TELEPHONIC
CARE BEYOND THE CURRENT
PANDEMIC. CURRENTLY OVER 60% OF
OUR VISITS ARE VIRTUAL BUT NO
MORE THAN 15% OF THE VIRTUAL
VISITS ARE COMPLETED BY VIDEO.
WE KNOW THAT HELLO HELLO THE
PHYSICALLY TELEPHONIC IS THE
SOLUTION TO ADDRESS. MANY
EXISTING HEALTH DISPARITIES.
MANY OF OUR PATIENTS. DON'T GET
PAID SICK TIME FROM THEIR
EMPLOYERS TAKING TIME OFF TO
VISIT THE CLINIC MEANS
FORFEITING INCOME. OF THE MANY
OF OUR PATIENTS RELY ON TIME
CONSUMING PUBLIC
TRANSPORTATION. BEING ABLE TO
SPEAK TO THE CONDITION OF THE
PHONE SIX AND PRECIOUS TIME AND
MONEY. AND ENSURE THAT THEY'RE
GETTING THE MEDICAL CARE THAT
THEY NEED. HELLO NO SHOW RATE
OF ONLY 4% FOR TALK ON A
DIFFERENCE OF ANOTHER EXAMPLE
OF HOW WELL IT IS WORKING FOR
OUR COMMUNITY. WE ARE GREATLY
CONCERNED THAT HEALTH CLINIC
VISITS ARE BEING LOCKED OUT OF
ADMINISTRATION TELEHEALTH
PROPOSAL. PLEASE DO NOT LEAVE
OUR COMMUNITY HOT MAKE SURE
TELEPHONIC CARE IS INCLUDED IN
ANY TELEHEALTH PROPOSAL THANK
YOU. THANK. YOU VERY MUCH OUR
NEXT CALLER PLEASE. AND THAT
COMES FROM. FIFTH FIVE. GOOD
AFTERNOON CHAIR MEMBERS JUSTIN
RAN OF THE CALIFORNIA DENTAL
ASSOCIATION WE WOULD LIKE TO
THANK THE ADMINISTRATION FOR
COMMITTING TO EXTEND THE
TELEHEALTH FACILITIES THAT WERE
ALLOWED DURING THE PANDEMIC IN
THE JANUARY BUDGET PROPOSAL
HOWEVER WE WERE DISAPPOINTED
WITH YOUR DEPARTMENT HE BIALIK
DOES NOT INCLUDE THE ABILITY TO
ESTABLISH A PATIENT EIGHTEENTH
IN A TELEHEALTH. AT HIGHLIGHTED
IN THE BACKGROUND PAPER THE
LEGISLATURE APPROVED AS A
MESSAGE TO TREAT A PATIENT WITH
THE PASSAGE OF AB TWENTY ONE
SIXTY FOUR IN TWENTY TWENTY THE
RECKLESS GENERAL HOME IS A LOT.
BIGGER THAN A WHOLE MODEL IF
THE PENCIL EVIDENCE BASED MODEL
FOR TELEHEALTH AND WHICH DENTAL
HYGIENISTS AND ASSISTANTS GO TO
COMMUNITY FIVE PROVIDE TO
PROVIDE DIAGNOSTIC PREVENTATIVE
AND EARLY INTERVENTION DENTAL
CARE IN PARTNERSHIP WITH THE
CLUB GRADING DENTIST. REVIEWS
RECORDS REMOTELY. LANGUAGE
BECAUSE OF THE TO UNDERMINE
UNDER MY THE EXISTING SUCCESS
MEDIA PROGRAM. D. A. APPLE YOU
PRESERVE NEXT DOOR AND FORMER
AND AS IN A LOT. THE LITTLE TO
WORKING CLOSELY. AS DEVELOP
INTO SO MUCH THANK YOU VERY.
THE NEXT COUPLE. AND THAT COMES
MIND. EIGHT H. GOOD AFTERNOON
THIS IS STEPHANIE FOR AND ON
BEHALF OF THE CHILDREN'S
PARTNERSHIP THANK YOU CHAIRMAN
AND HELP COMMITTEE MEMBERS FOR
TODAY'S HEARING. WE ARE STRONG
SUPPORTERS OF INCREASING ACCESS
TO TELEHEALTH FOR FAMILIES OF
COLOR AND LOW INCOME FAMILIES
IN CALIFORNIA. WE APPRECIATE
DHS'S PRESENTATION TODAY AND
THE ADMINISTRATION'S DESIRE TO
MAKE PERMANENT TELEHEALTH
LEXIBILITY IS. HAVE BEEN
GRANTED DURING THIS PUBLIC
HEALTH EMERGENCY. HOWEVER WE DO
HAVE CONCERNS ABOUT THIS
PROPOSAL AND THE RESTRICTIONS
IT PLACES ON COMMUNITY CLINICS
IN THE PATIENTS NAY SAYERS. WE
FEEL THE PROPOSAL IN THE
TRAILER BILL LANGUAGE IN ITS
CURRENT FORM WOULD BE A MOVE
AWAY FROM EQUITY AND A MOVE
AWAY FROM ENSURING THAT
CHILDREN AND FAMILIES WHO NEED
CARE THE MOST ARE ABLE TO GET
IT. WE STRONGLY URGE THE
LEGISLATURE AND THE
ADMINISTRATION TO RECONSIDER
AND ENSURE COMMUNITY CLINICS
CAN ESTABLISH PATIENTS USING
ASYNCHRONOUS TELEHEALTH. AND BE
REIMBURSED FOR AUDIO ONLY
TELEHEALTH. BOTH ASYNCHRONOUS
TELEHEALTH AND AUDIO ON THE
TELEHEALTH ARE BOTH CRITICAL
MODALITIES OF CARE ESPECIALLY
FOR THE THOUSANDS OF
CALIFORNIANS WHO LACK ADEQUATE
BROADBAND ACCESS AND COMPUTER
THE VIDEO CAMERAS IN THEIR
HOMES. WE LOOK FORWARD TO
WORKING WITH THE LEGISLATURE
AND THE ADMINISTRATION TO
ENSURE OUR STATE'S TELEHEALTH
POLICIES. SERVE OUR POPULATIONS
AND DO NOT CUT OFF COMMUNITIES
OF COLOR AND LOW INCOME
COMMUNITIES FROM ACCESSING CARE
THANK YOU. THANK YOU VERY MUCH
NEXT CALL PLEASE. THANK YOU AND
THAT COMES FROM LINE FORTY ONE
PLEASE GO AHEAD. THANK YOU-
GOOD EVENING CHAIR WOULD IN
MEMBERS OF THE COMMITTEE THANK
YOU FOR HOLDING THIS HEARING
I'M TACKLER IS RENEE HEALTH
TECHNOLOGY STRATEGIST WITH
BACKGROUND AS A SOFTWARE
DEVELOPER TRAUMA SURGEON
CLINICAL LEADER IN HEALTH
POLICY ADVISER- THERE'S NO
BETTER PERSON TO TALK ABOUT
TELEHEALTH POLICY THAN IS QUAN.
WHO PROVIDE AN EXCELLENT
FOUNDATION FOR YOUR TELEHEALTH
DISCUSSION TODAY- BUT I WANTED
OFFER A SMALL AMENDMENT TO HER
DEFINITION OF REMOTE PATIENT
MONITORING. IT MIGHT NOT BE
CONTINUOUS IT COULD BE
EPISODIC. THIS IS IMPORTANT AS
YOU LOOK AT NEW SERVICES SOME
ALREADY COVERED BY MEDICARE FOR
THE PATIENT OF THE MONITORING
SERVICE WHICH IS CONTINUES ON A
DAILY BASIS. BUT THE DATA
TRANSMITTED IS ONLY OF THE
SONIC. AND A SMALL ME ONCE IT
MIGHT HAVE SIGNIFICANT POLICY
IMPLICATIONS IF YOU LOOK AT THE
CATEGORY OF TELEHEALTH IN THE
FUTURE- IN TERMS OF TELEHEALTH
COMPARABILITY TO IN PERSON
CLINICAL ASSESSMENT I HAVE TWO
COMMENTS. FIRST WE DON'T HAVE
GOOD DATA ON OUTCOMES IN
HEALTHCARE GENERALLY. BECAUSE
WE DON'T MEASURE AND REPORT
THINGS LIKE RATES OF BREAST
CANCER MORTALITY HYPERTENSIVE
STROKE OR DIABETIC FOOT
AMPUTATIONS. THOSE CLINICAL
OUTCOMES WOULD LET US KNOW HOW
WE'RE DOING BUT WE DON'T
MEASURE AND REPORT THEM.
INSTEAD WE MEASURE THINGS LIKE
RATE OF MAMMOGRAPHY WHICH
DOESN'T TELL US ANYTHING ABOUT
THE ACCURACY OF THE STUDY OR
THE RADIOLOGIST INTERPRETATION.
THE RATE OF UNNECESSARY
BIOPSIES ARE MISSED CANCERS ALL
OF WHICH ARE CAPTURED IN BREAST
CANCER MORTALITY IN AGGREGATED
FORM. THE FLAG OF OUTCOME DATA
LIMITS OUR ABILITY TO KNOW HOW
TO LOVE COMPARES. BECAUSE OUR
BASELINE QUALITY DATA IS
INADEQUATE. SECOND STUDY THAT
EXAMINED COMPARABILITY OF
TELEHEALTH TEND TO BE DISEASE
SPECIFIC CONSISTENT WITH THE
CLINICAL TEST MONEY HEARD FROM
DOCTORS MENTAL CORRUPTION AND I
AM. AN ASSESSMENT OF A
PSYCHIATRIC ISSUE MIGHT BE MORE
EFFECTIVE BY TELEHEALTH AND IN
PERSON. A SKIN LESION%
EVALUATION MIGHT BE COMPARABLE
BUT AN ASSESSMENT OF THE CUTE
OF DOMINO PAIN WITHOUT AN
EXAMINATION. WILL CERTAINLY BE
LIMITED COMPARED TO THE TOUCH
AN EXPERIENCED POLITICAL HANDS.
CONSISTENT WITH YOUR WOOD
STATEMENTS PAYMENT PARITY
SHOULD BE BASED ON CLINICAL
PARITY. ALL THAT COULD BE IS A
VERY IMPORTANT DISCUSSION.
SEPARATE FROM PAYMENT PARITY
PAYMENT FOR TELEHEALTH SERVICES
TO ENSURE ACCESS ABSOLUTELY.
PAYMENT PARITY TO IMPROVE
ACCESS HE WON THE SERVICES PLUS
EFFECTIVE PROBABLY NOT. BECAUSE
THAT COULD CREATE UNINTENDED
NEGATIVE CONSEQUENCES. THE
PAYMENT PARITY DISCUSSION AND
THE TELL OF EQUITY DISCUSSION
MUST BE SEPARATE EVEN THOUGH
THEY'RE CLEARLY RELATED. AND
THEN LAST PLEASE JUST MENTION
BY CMA HEALTHEQUITY DOES
REQUIRE INFRASTRUCTURE
IMPROVEMENTS LIKE ASSEMBLY
MEMBER AGIR TREES EIGHTY
FOURTEEN TO ENSURE THE
UNDERSERVED COMMUNITIES HAVE
ACCESS TO TELEHEALTH. THANK YOU
FOR ACCEPTING PUBLIC INPUT- I'D
BE HAPPY TO EXPAND ON THESE
COMMENTS IN THE A LONGER
OPPORTUNITY IN THE FUTURE.
THANK YOU VERY MUCH- NEXT
CALLER PLEASE. THANK YOU NEXT
LINE FORTY TWO. I THINK YOU CAN
MEMBERS MY RETIREMENT PLAN HOW
TO FIGHT THE CALIFORNIA.
ENDOWMENT AGAIN CLINTON SEVEN
AFFILIATES HAVE IMPLEMENTED
INNOVATIVE HEALTHCARE DELIVERY
APPROACHES TO CONTINUE SERVING
OVER SEVEN HUNDRED THOUSAND
PATIENTS IN THE STATE INCLUDING
SUBSTANTIAL INVESTMENTS AND HOW
HOW DOES NOT FORGE ABOUT A
QUARTER THINKING HAD SERVICES
IN THE STATE HAVE BEEN PROVIDED
VIA TELEHEALTH BUT OVER HALF OF
THOSE THAT HAVE BEEN CONDUCTED.
OF AUDIO ONLY OUR HEALTH BUT-
IN SOME OF OUR- HELLO THIS IS
MADE UP CIRCUIT PERCENT OF ALL
THAT BUT- ENTAILS UNDER THAT
BECOME ABSOLUTELY. FOR PATIENTS
DO NOT HAVE RELIABLE CONNECTION.
AND ARE FROM HOME PRIOR OR THE
TWO CAN. AND THEREFORE CHOOSE
AUDIO ONLY CARE. THROUGH
TELEHEALTH CLAIM PUBLICATIONS
HAVE BEEN ABLE TO ACCESS A WIDE
RANGE OF HEALTH CARE SERVICES
LIKE BIRTH CONTROL. STI
SCREENING PREGNANCY COUNSELING
GENDER AFFIRMING CARE HAPPENED
A LOT AGI SCREENING. WELCOME TO
CONTINUE TO DEEPEN INEQUITIES
WITHIN THE HEALTHCARE SYSTEM WE
CAN'T INTENTIONALLY IMPROVE
ACCESS TO MEDICAL PATIENTS BY
ENSURING OUR TELEHEALTH POLICY.
ALLOWED FOR MEDICAL PATIENTS TO
ACCESS SERVICES THROUGH
TELEHEALTH APPLICATIONS. OF
COMMERCIAL INSURANCE. YES YOU
CAN CLOSE ALL IN. AND PERSONAL
PULSAR ABOUT HOW NEED INTO
THEIR CAL- YOU BRIDGE THAT
ABOUT MEDICAL PATIENTS CONTINUE
PAYMENT FOR TELL. BUT THAT.
REIMBURSING ALL ONLY OR HELP
THAT NEW PIECE. AND ALLOW FOR
MORE RURAL MEMBER TONE WRONG
INTO LITTLE SCOPE PART. LOOK
FOR CONTINUE CONVERSATION THE
COMMITTEES ARE ONS ABILITY TO
TWO WORKING FOR MORE ACT.
COMPONENTS BUDGET AND ENSURE
ALL PATIENT. AND I WANT
INSURANCE THEY HAVE HAVE ACCESS
TO TOP SERVICES APPROPRIATE.
THANK YOU. THANK YOU VERY MUCH
THE NEXT PLEASE. THANK YOU AND
THAT COMES FROM TWENTY NINE
PLEASE AHEAD. THANK YOU MISTER
CHAIRMAN KATEY LEIGHTON BE
HAPPY THE CHILDREN SPECIAL CARE
BECAUSE- ONE STRONG SUPPORTER.
TO TELL PLEXUS IS IMPLEMENTED
DURING THE PANDEMIC LIKE THE
PEACH YEARS OVER THE RAPID AND
SUCCESSFUL SCALING UP
TELEHEALTH HAS ALLOWED
PEDIATRIC SUBSPECIALISTS TO
REMAIN IN CLOE CONTACT WITH
THEIR PATIENTS WHEN THEY NEED
IT THEM OUT. IT CHILDREN YOUTH
AND THEIR- TO KEEP THE POINT
SCHOOL FIND CHILD OR TRAVEL TO
THE HOSPITAL. THIS IS
PARTICULARLY IMPACTFUL TO
CHILDREN AND YOUTH WITH COMPLEX
HEALTH CARE NEEDS TO
OFTENTIMES. HAVE MEDICAL
APPOINTMENTS AND MANY TO SEE
MULTIPLE SPECIALISTS TO TREAT
THEIR CONDITION. WELL WE'RE
INITIALLY PLEASED TO SEE THE
EXPANSION OF TELEHEALTH POLICY
AND PHD AT THE PROPOSAL WE DO
HAVE CONCERNS BUT IT DOES NOT
GO FAR ENOUGH AND COULD
EXACERBATE DISPARITIES FOR LOW
INCOME PATIENTS. PARTICULARLY
THOSE THAT ACCESS CHARACTER
ACTUALLY USE AND HAVE LIMITED
ACCESS TO TECHNOLOGY ARE BROAD
AND- TELEHEALTH HAS AN
IMPORTANT ROLE TO PLAY AND
HEALTHCARE DELIVERY ON THE ON
THE PHD. BUT WE MUST ENSURE IT
WORKS WELL FOR ALL CALIFORNIANS
REGARDLESS OF RACE ETHNICITY
AGE OUR PRIMARY LANGUAGE
SPOKEN. THANK YOU FOR YOUR TIME
TODAY AND FOR HOSTING THIS
IMPORTANT HEARING. THANK YOU
VERY MUCH NEXT CALLER PLEASE.
BACKUP TO MIND. ONE THANK YOU
MISTER CHAIR MEMBERS OF THE
ASSEMBLY HEALTH COMMITTEE MY
NAME IS CODY KATHY AND I'M
CALLING ON BEHALF OF THE
CENTRAL ACCESS HELLO. WE NEED
THE LARGEST AND MOST
COMPREHENSIVE TITLE PAN FEDERAL
FAMILY PLANNING PROGRAM
PROVIDER NETWORK IN THE COUNTRY
I KNOW WE ARE NETWORK INCLUDE
FAMILY PLANNING PROVIDERS SB
PREVENTION PARTNERS AND THE ALL
COLLECTIVELY SERVE EIGHTEEN
ACROSS TWENTIETH CALIFORNIA'S
COUNTY. AND WE'RE CONCERNED
THAT THE ADMINISTRATION WILL
HELP PROPOSAL WILL PREVENT
PEOPLE FROM ACCESSING ESSENTIAL
SEXUAL AND REPRODUCTIVE HEALTH
CARE BEYOND THE PANDEMIC PART
OF PROVIDING QUALITY CARE FOR
TIME SENSITIVE SERVICES LIKE
CONTRACEPTION AND RELATED
SERVICES INCLUDE THE ABILITY TO
GET THE SIMPLE CHOICE WHETHER
TO IN PERSON VISITS VIDEO OR
AUDIO ONLY THAT THAT. I THOUGHT
HELP INCREASES ACCESS TO BE
VITAL SERVICES AND REDUCES
BARRIERS TO CARE LIKE I'M AWAY
FROM WORK FAMILY HEALTHCARE
ISSUES AND CONFIDENTIALITY
CONCERNS AND THE PEOPLE OF
COLOR WHO ARE OFTEN
EXPERIENCING BARRIERS WHICH IS
WHY ONGOING COVERAGE AND
PAYMENT PARITY. THE FUNNY CARE
WILL HELP CREATE A MORE
EQUITABLE HEALTHCARE SYSTEM IN
OUR STATE AND PATIENT HI
EXPRESSED THAT RECEIVING CARE
VIA PHONE IS AN OPTION THEY
NEED IT'S PAST SUMMER WE
SURVEYED OVER FOUR HUNDRED
EIGHTEEN YOUR SOCIAL MEDIA
NEARLY 50% SAID THEY WOULD BE
MUCH MORE LIKELY TO GET CARE
USING TELEHEALTH MEN IF THEY
HAD TO GO INTO A CLINIC AND THE
PROPRIETOR OVERWHELMING
MAJORITY SAID THEY PREFERRED
BUSINESS TO TAKE PLACE OVER THE
PHONE. FIRST VIDEO THEY NOTED
PRIVACY EASE OF ACCESS AND LESS
INTIMIDATING AS REASONS WHY THE
PREFERRED TELEPHONIC AND
VIRTUAL VISIT WE ALSO SURVEYED
OUR PROVIDER NETWORK
RESPONDENTS REPORTED THAT
NEARLY 60% OF THEIR VIRTUAL
SEXUAL AND REPRODUCTIVE HEALTH
VISITS WERE CONDUCTED BY
TELEPHONE I MAJORITY REPORTED
THAT MORE THAN HALF OF THEIR
PATIENTS. ARE EXPECTED TO
CHOOSE A TELEHEALTH VISIT OVER
IN PERSON CARE BY APRIL OF THIS
YEAR I'LL HELP REDUCE PATIENT
WAIT TIME SO THEY CAN. GET THE
CARE THEY WANT WHEN THEY NEED
IT WHERE THEY ARE. SO THANK YOU
FOR TIME AND YOU FOR ALL THE
WORK THEY PUT IT. THANK YOU
VERY MUCH NEXT PLEASE. AND THAT
COMES MIND. ONE THANK YOUR
MENTOR TO MEMBERS MY CONSUMERS
BEHALF OF CALIFORNIA HEALTH
ADVOCATES AND CUT A COMMITTEE
OPENERS AFTER EACH SEASON ARE
AGENCIES PROVIDE COMPREHENSIVE
PRIMARY CARE SEVEN POINT FOUR
MILLION PEOPLE IN CALIFORNIA
AND ONE IN THREE MEDIC HELP
PATIENT. LIKE TO THANK YOU
MISTER CHAIR THE COMMITTEE
STAFF AND THE PANELISTS THE
HOLDEN APPEARING I WAS ONLY
GOING TO TALK ABOUT TELEHEALTH
IT'LL DO MY BEST TO LOOP AND
THE EIGHT PM TO. MAYBE HEALTH
CENTERS TELL IS A STATE THAT.
BEEN PROVEN OF THAT HAS THE SO
OF THE PATIENTS AND- IT SHOULD
BE CONSIDERED AS A TOOL TO
ADDRESS EXISTING HEALTH
DISPARITIES AND SOCIAL
DETERMINANTS OF HEALTH. AND
MARK PROUD CO SPONSOR OF THE
FAMILY AND ONE AGUIAR-CURRY AB
THIRTY TWO ON THIS VERY ISSUE.
AS WE LOOK FORWARD WE HAVE TO
ACKNOWLEDGE THAT HAVE BEEN
WORKING FOR THE PAST ELEVEN
MONTHS WE ARE GRATEFUL FOR THE
PORTION OF THE ADMINISTRATION'S
PROPOSAL THAT WOULD LIFT
RESTRICTIONS. FOR CLINICS TO
PROVIDE VIDEO VISIT HOWEVER ANY
PROPOSAL THAT ELIMINATES FQHCS
ARE EACH THESE ABILITY TO
PROVIDE. AUDIO ONLY. AN
ASYNCHRONOUS STORE AND FORWARD
CARE AND PROHIBITS CLINICS FROM
PROVIDING. REMOTE PATIENT
MONITORING IS NOT EQUITABLE AND
WILL DISPROPORTIONATELY IMPACT
HEALTH CENTER PATIENTS. BY
TAKING AWAY PATIENT CHOICE TO
ACCESS THESE MODALITIES WHICH
IS A PARTICULAR NEED TO ADDRESS
THE DIGITAL DIVIDE THAT WAS
DISCUSSED EARLIER- BY EXCLUDING
ONE PROVIDER SETTING FROM
OFFERING ALL THESE MODALITIES
THAT COULD PROPEL A POST
PANDEMIC MEDICAL SYSTEM WHERE
PATIENTS WHO CHOOSE TO RECEIVE
THEIR CARE A HEALTH CENTER. ARE
OFTEN A DIFFERENT AND PERHAPS
LOWER TIER OF ACCESS TO CARE
AND COULD ALSO EXACERBATE THE
WORKFORCE CHALLENGES THAT
ALREADY EXISTED HEALTH CENTER.
WE ARE ENCOURAGED TO HEAR THEIR
RENEWED INTEREST. IN
ALTERNATIVE PAYMENT
METHODOLOGIES HOWEVER AT NOTED
THERE IS A DIFFERENCE OF
OPINION ABOUT HOW THE EPM MUST
BE ACHIEVED. ON THE STATE SIDE
AND THE FEDERAL SIDE AND SO FAR
NOT NOT THE TYPE BY ALL THE
PARTIES TO COME TO A RESOLUTION
SO THAT THAT'S NOT SOMETHING.
THAT IN PLACE TODAY AND WE DO
NOT HAVE A CLEAR SENSE OF
TIGHTENING. HONEST EFFORTS WE
WOULD ASK THAT AT THE VERY
LEAST AT THE CONSIDERATION OF
THE BRIDGE UNTIL WE GET TO. PM
WE LOOK FORWARD TO ENGAGING
YOU- THE LEGISLATURE AND THE
ADMINISTRATION TO ACHIEVE
EQUITY AND ACCESS TO TELEHEALTH
FOR HEALTH CENTER PATIENT THANK
YOU VERY MUCH. THANK YOU VERY
MUCH. NEXT COURT NEXT CALLER
PLEASE. AND THAT COME TO MIND.
SIX GOOD AFTERNOON DIANA
DOUGLAS I'M BEHALF OF THE- WE
TODAY'S THE IN THE PROGRESS
PAUL PROPOSAL THAT HAVE BEEN
MADE OVER THE PAST YEAR WE
SUPPORT CONTINUING TELEFLEX
ABILITY POST PANDEMIC THE LONG
AS WE CAN ENSURE CONSUMERS ARE
ALWAYS ABLE TO CHOOSE IN PERSON
CARE IF THEY PREFER. MEDIKAL
AND REALLY SHOULD HAVE THE SAME
ACCESS TO VIRTUAL CAROUSEL AND
THOSE IN THE COMMERCIAL MARKET
WE DO BELIEVE THAT PART OF
ENSURING EQUITABLE ACCESS IS AT
LEAST FOR THE TIME BEING
REIMBURSING AUDIO ONLY CALLS AT
PARITY WITH VIDEO MANY PEOPLE
DON'T HAVE THE VISION
TECHNOLOGY OR THEY CAN'T AFFORD
DATA PLANS TO SUPPORT IT.
OTHERS MAY PREFERIDEA ONLY FOR
THE PRIVACY IT AFFORDS
PRESERVING ACCESS TO AUDIO
QUALITY IS AN IMPORTANT EQUITY
COMPONENT. THAT YOU TO CONVERT
BACK ON TODAY- WAS VERY HELPFUL
IN TERMS OF LAYING OUT WHAT WE
CURRENTLY KNOW ABOUT HOW
TELEHEALTH MODALITIES AFFECT
ACTUAL HEALTH OUTCOMES WE
STRONGLY ADVOCATE FOR ABOUT
DATA AND EVALUATION PLANS TO
COINCIDE WITH THE EXPANSION OF
TELEHEALTH BACK THE DELEGATES.
RIGHT NOW WE HAVE A GOLDEN
OPPORTUNITY TO HAVE A
THOUGHTFUL DATA DRIVEN APPROACH
THAT WILL HELP US UNDERSTAND
HOW TELEHEALTH IS AFFECTING
ACCESS EQUITY AND HEALTH
OUTCOMES IN OUR DIVERSE
POPULATIONS. THANK YOU SO MUCH
FOR THE CONVERSATION TODAY.
THANK YOU VERY. OUR NEXT CALLER
PLEASE. THANK YOU IN THAT COME
TO MIND SIXTY SEVEN. GOOD
AFTERNOON MR CHAIRMAN BURKE-
GEAR ON BEHALF OF FORTY NINE
THANK WILL CONTINUE TO CARRY
THEM PROVIDING THE OPPORTUNITY
TO PROVIDE COMMENT THE MARKET
ON YOU KNOW THAT EARLY AND
TIMELY ACCESS TO PRENATAL CARE
IS CRITICAL TO ENSURING BETTER.
BIRTH OUTCOMES FOR ALL MARKET
BABIES WORK LIFE SUPPORTS
INCREASED ACCESS TO TELEHEALTH
SERVICES THAT ONLY DELIBERATE
BARRIER REDUCE DISPARITIES
ACCESS EARLY PRENATAL CARE TO
IMPROVE BIRTH OUTCOMES MY
CLIENT ADVOCATE FOR ALL CARE TO
PROVIDE COVERAGE FOR. BASIC
HEALTH SERVICES FOR PREGNANT
AND POSTPARTUM WOMEN AT THE
PORT THE LION MEDICAL HEALTH
REIMBURSEMENT PROCESS ACROSS
PAYER. TO BE GREEK AWESOME
ASSEMBLY ECHO THE COMMENTS THE
PREVIOUS SPEAKER REGARDING.
THANK YOU ADMINISTRATE PROPOSAL
AT THE ROD BY SAYING THAT IN
ADDITION TO THOSE CONCERNS
MARKET BY URGE THAT ANY HOW DO
YU CAN INCLUDING GREED. AND
EVALUATION CALIFORNIA WITH BOTH
PART OF WHAT AT THE START OF
THE BASED EFFECTIVE CARE
PUTTING CONFIRM MOTHER. THANK
THANK YOU VERY MUCH- NEXT COURT.
THANK YOU AND THAT COMES TO MY
FIFTY. I AFTERNOON. MY NAY IS
KARLEY ON AND I AM A SENIOR OF
NATIONAL PROPER. KNOWN AS AND
HOPE WE PROTECT ADVANCE HEALTH
BY HELLO INCOME UNDER
INDIVIDUALS. SIMILAR TO AND
HELP MEDICARE PRINCIPLE FROM
TELE WE COMMEND THE- SPENT THE
BOTH TO A AT ACCESS. PATIENT
GENERAL CARE I'M COMPANIES SHE-
THAT COULD BE NINETY PUBLIC
HEALTH AMERICA HAS REVEALED
THAT MANY THAT THAT. BY
ANDERSON HELP PARTICULARLY-
THEY MADE IT- ACCESS TO
BROADBAND EQUIPMENT AND DIGITAL
LITERACY. ALTHOUGH ADDITIONAL
EFFORT SHOULD BE MADE SO THAT
THIS UTILITIES BECOME
UBIQUITOUS IN THE STATE WE
STRONGLY SUPPORT ALLOWING THE
USE OF TELEPHONIC AUDIO ONLY
CERVANTES SO THE LOW INCOME AND
UNDERSERVED POPULATIONS RECEIVE
ACCESS TO HEALTH CARE WHEN THEY
NEED IT. TELEPHONIC AUDIO ONLY
SERVICES SHOULD ALWAYS BE
ALLOWED AND PAYMENT EQUITIES
SHOULD BE CONSIDERED WHEN
PATIENTS HAVE NO OTHER MEANS TO
RECEIVE HEALTH CARE I NEED THE
SERVICE IMMEDIATELY. WE THANK
YOU FOR YOUR TIME AND YOUR
LEADERSHIP. AND LOOK FORWARD TO
WORKING WITH YOU. THANK VERY
MUCH CALLER PLEASE. AND THAT
COMES TO MIND FIFTY TWO. THANK
YOU DOCTOR WHEN NUMBER SERVERS
ON BEHALF OF THE ASSOCIATION OF
CALIFORNIA HEALTHCARE
DISTRICT'S CULTURE DISTRICTS OF
ALL QUITE TELL HOW TO DELIVER
PRIMARY AND SPECIALTY CARE
THEIR COMMUNITIES HOW HOW
PRESERVATION AND EXPANSION ARE
ESSENTIAL TO ACCESS TO CARE
THROUGHOUT CALIFORNIA
ESPECIALLY IN RURAL AND
UNDERSERVED AREAS OF THE STATE.
BEEN WORKING OUT THAT ARE ALL
CALIFORNIANS HAVE ACCESS TO
HIGH SPEED INTERNET CABLE WILL
BELONG THANK GOODNESS TELL OUT
WITHOUT PARITY ACROSS
MODALITIES INCLUDING TELEPHONIC
REMOTE PATIENT MONITORING AND
OTHER FORMS MASON CONNECT CARE
TELEHEALTH WILL NOT MAKE
MEANINGFUL STRIDES IN
DELIVERING CARE TO THOSE WHO
GET THEM OUT. FOR THESE REASONS
WE HAVE SIGNIFICANT CONCERNS OF
THE DHS PROPOSAL TO CREATE A
SEPARATE FEE STRUCTURE I'M
BROUGHT BACK MANY OF THE
CURRENT TELEHEALTH SERVICES FOR
ASYNCHRONOUS CARE WE LOOK
FORWARD TO CONTINUING THE
CONVERSATION WITH THE
LEGISLATURE AND STAKEHOLDERS TO
EXPAND ACCESS TO AFFORDABLE
QUALITY HEALTHCARE FOR ALL
CALIFORNIANS THANK YOU. THANK
YOU VERY MUCH NEXT CALLER
PLEASE. AND THAT COMES TO MIND.
EIGHT YES CLAUDIA WITH- CAL TO
TRUST- WE ARE IN THE WORK TO
ADDRESS THE MENTAL HEALTH
CRISIS FACING ARCH AND YOUTH-
THANK YOU MISTER CHAIR MEMBERS
OF THE COMMITTEE AND ALL THE
PRESENTERS THE CHANCE TO SHARE
THESE THOUGHTS ON. EVIDENCE OF
THE YOUTH MENTAL HEALTH CRISIS
IS STAGGERING I INCREASES IN
SUICIDE ANXIETY AND DEPRESSION
WERE ALREADY AT UNACCEPTABLE
AND ALARMING LEVELS FOR THE
PANDEMIC. AND THEY ARE NOW EVEN
WORSE- WE STRONGLY SUPPORT
TELEHEALTH BUT ANY SOLUTION
THAT EXCLUDES REIMBURSEMENT
PARITY FOR PHONE. AND THE
INCLUSION OF TAX. SPECIALLY FOR
YOU MENTAL HEALTH IS MISSING OF
THE- WAYS WHICH YOU CAN AND CAN.
TO THEIR THERAPIST COUNSELORS
PEERS AND OTHER SOCIAL SUPPORT-
WE'VE HEARD STORIES ABOUT TEXT
MESSAGES INTENTIONALLY SAVING
LIVES DURING THE PANDEMIC. AND
FOR THE THOUSANDS WHO LACK
BROADBAND ACCESS AND VIDEO
CAPABILITIES THE PHONE AND TAX
ARE THEIR MAIN ACCESS POINTS-
ON. AN EQUITY ISSUE AND THE
MOMENT TO BE USING EVERY
POSSIBLE CHANNEL TO HELP OUR
YOUNG PEOPLE NOT TO BE LIMITING
OR UNDER FUNDING TOOLS WE NOW
ARE HELPING. I'M WE URGE THE
LEGISLATURE IN THE
ADMINISTRATION TO ENSURE
REIMBURSEMENT TO ALL MEDIC HELP
PROVIDERS FOR PHONE INTACT. AND
WE LOOK FORWARD TO WORKING WITH
YOU ON THIS ISSUE THANK YOU SO
MUCH. THANK. YOU VERY MUCH OUR
NEXT CALLER PLEASE. THANK YOU
AND THAT COMES LINE. SEVENTY
NINE. MEMBERS OF THE ASSEMBLY
HEALTH COMMITTEE I IN JULIA AND
I AM SPEAKING ON BEHALF OF THE
CALIFORNIA JUDGE INSTRUCTS
THANK YOU FOR GIVING US THE
OPPORTUNITY TO SHARE THIS
EXPERIENCE. AND MY EXPERIENCE
WITH TELEHEALTH DURING COLD AND
I URGE THE STATE YOU'RE IN FOR
EXPECTING AND PHONE
REIMBURSEMENT AND MEDIKAL
PERSONALLY NIGHT. AND PEOPLE MY
AGE I'M IN HIGH. TEXTING IS
USUALLY THE WAY WE CAN. AS WELL
AS- OVER THE PHONE A LOT OF
PEOPLE HAVE SOCIAL ANXIETY
INCLUDING MYSELF PROTECTING.
AND OVER THE PHONE CALLS ARE
LESS STRESSFUL. WE HAVE SUICIDE
HOTLINE AND ALSO TO SETUP LIVE
CHAT. MOST PEOPLE WOULD GO LIKE
ME TO TAX SOMEONE THEY KNOW
OVER SOME RANDOM PERSON OVER A
CHAT. I WOULD HAVE MADE IT TO
MY CRISIS WITHOUT TEXTING MY
THERAPIST. AND OTHER PEOPLE DO
NOT HAVE ACCESS TO STABLE
NETWORK TO SUPPORT THE VIDEO
CALLED. WE DO NOT TAKE FOR
GRANTED THESE IMPORTANT
CHANNELS OF COMMUNICATION I
HAVE BEEN SO SIGNIFICANT TO ALL
IF YOU COULD APPEND ON THEM
THANK YOU. THANK YOU VERY MUCH
NEXT CALL PLEASE. THAT COMES
FROM THE LINE EIGHTY. HELLO
MISTER CHAIR MEMBERS ADAM THIS
IS SERRA FLOCKS I'M
REPRESENTING THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK AND HE
PENNED A PLOT TO THE GOVERNOR'S
PROPOSAL TO EXPAND AND MAKE
PERMANENT THAT THE TELEHEALTH
FLEXIBILITY FOR MEDICAL
PROVIDERS THE PANDEMIC HAS
ACCELERATED AND EXPANDED THE
USE OF TELEHEALTH WITH THE
RAPID DEPLOYMENT AND THIS MAKES
IT EVEN MORE IMPORTANT THAT THE
LEGISLATURE AND THE
ADMINISTRATION. CONSIDER EQUITY
AND THE NEEDS OF BLACK
INDIGENOUS AND PEOPLE OF COLOR
AND LOW INCOME PATIENTS PEOPLE
WITH DISABILITIES AND LIMITED
ENGLISH SPEAKERS IT'S ALSO
IMPERATIVE TO ENSURE EQUITABLE
ACCESS ESPECIALLY FOR THOSE IN
RURAL AREAS THAT EXPERIENCE
DIGITAL BARRIERS AT HIGHER OF
LATE. AND SO OUR RECOMMENDATION
WOULD BE TO MOVE FORWARD WITH
TELEHEALTH INVESTMENT AND
INCREASE THE INVESTMENT AND
TARGET THE DOLLARS TO ENSURE
EQUITABLE ACCESS TO ADOPTION OF
BROADBAND AND FIBER OPTICS
DIGITAL CELLULAR TECHNOLOGY
REIMBURSEMENT FOR TEAM BASED
CARE AND EXPANDED ACCESS TO
APPROPRIATE PATIENT TOOLS AND
SUPPORT. THANK YOU VERY MUCH
FOR HOLDING THIS IMPORTANT AND
VERY TIMELY HEARING THANK YOU
THANK. YOU VERY MUCH NEXT
CALLER PLEASE. THAT COMES FROM
A LINE NUMBER NINE. GOOD
AFTERNOON HELLO COMMITTEE THANK
YOU SO MUCH FOR OUR HEARING IS
OUT TODAY MANY OF THE PRODUCTS
AT THE END YOU KNOW I'M HERE-
MAKING A STATEMENT ON BEHALF OF
DOCTOR MORGAN PRICES WHICH IS A
DECISION A PLANNED PARENTHOOD
ARMANTI IN MARCH THAT. ALL
RIGHT HERE A STATEMENT HI A
NINE OLD. PLEASE WITH SOME
BATES CHRONIC CONDITIONS WITH A
THANK. PARENT OF THREE. WORK
FULL TIME AND MISSED
APPOINTMENTS IN THE PAST TWO
TWO. CA SHE WAS. IN THE CALL BY.
IN THE AYE. FOR ONE MONTH.
THANK YOU BETA AND ON REYNOLDS
TODAY. UPON DISCHARGE HE WILL
HOME BOUND TO ICY YOU RELATE IN
A SEVERE IN EARLY TO THE
CONDITION I'M GOING TO ASIA ON
A- AND PTSD HER HOSPITAL.
MAKING DRIVING UNSAFE FOR HER
SHE LIVES THREE OUT OF LIFE TOP
IN OUR COMPLEX I WAS ABLE TO
CONVERT TWO DAYS AFTER
DISCHARGE HIM WITH YOUR
PRESIDENT IN MAKE A TREATMENT
PLAN. I WAS ABLE TO FACT TO
HOME HEALTH ORDER BROUGHT
BLOODWORK IT SHOWS AT THE MULTI
I HAVE BEEN FOR IN MANAGING
BROKER WILL BE WITH HER SHE HAS
NEVER MET A PHONE CALL IN DUE
TO PERSON SO I DON'T. I DO ABLE
TO CHECK ON HER ON A REGULAR
BASIS FOR HER SAFETY AND SHE
HAS BEEN UNABLE TO FIND A
COUNSELOR. WHO TAKES MEDICARE.
I'VE ALSO HEARD MANY OF OUR
PATIENTS PRICE. FOR HAVING
TELEHEALTH WITH CREDIT. FROM
FROM THE SAVINGS ON SHALL.
WHICH STAYED WITH ACT AS THEY
ACTUALLY HAVE TO BE FOR BURKE
IN FOR THE RAY PLAN. OR
PARSIPPANY IN I'M MORE HOURS
AND PUBLISHED. A BACK AND FORTH.
THE TWENTY FOURTEEN LIKE UP ON
MEDICATION TO TRY TRADE AS
NEEDED AND REVIEW CHRONIC
CONDITIONS AND MEDICATIONS FOR
SAFETY. WE THANK YOU SO MUCH
IMPROPERLY TAKEN ON THIS ISSUE.
THANK YOU VERY MUCH FOR
LISTENING. THANK YOU VERY MUCH-
NEXT CALLER PLEASE. THANK YOU
AND AGAIN ONE ZERO IF YOU WOULD
LIKE TO SHARE A COMMENT AND OUR
NEXT LINE IS LINE EIGHTY ONE
PLEASE GO AHEAD. HEY I'M HUMAN
I THANK YOU GUYS FOR LISTENING-
HE BASICALLY. BEING A VERY SELF
CONSCIOUS PERSON AND A WOMAN
WHO SUFFER ANXIETY HE AND I
FEEL- THANK YOU ALL THE TIME
AND SELECTED VERY JUDGMENTAL
WHEN I WAS IN THERAPY AND- MY
THERAPIST. ALSO VERY ANXIOUS
AND NERVOUS AND BEING ABLE TO
TALK TO HER ALL NINE NINE ALSO
I WAS MORE COMFORTABLE. BUT
EXPECTING WELL DONE AND SHE WAS
ABLE TO LISTEN AND I DIDN'T
HAVE TO FEEL LIKE YOU JUST MOVE
BACK FOR INSTANCE MENTAL
BECAUSE IF I FELT REALLY BAD
ECONOMIC GIPSON CAMEL. OR NOT
DOING THAT DAY- I LIVED THAT
THE MATTER. OKAY FROM THAT MAY
BACK IN QUESTIONS NOT POP. WITH
KOBE THIS IS JUST GOT HARDER
AND MONEY HEALTH WAS JUST
GETTING WORSE AND WORSE AND
WORSE AND SHE- THANKS TO CALL
THE MY IS ABLE TO CREATE. AN X.
AVENUE FOR ME. TO LISTEN. AND
EVERYTHING LIKE THAT- THE WEEK
AND EVERYTHING. AND CONCERNING
THE FACING THE FLEXIBILITY TO
KOBE ARE ISN'T GOING FOR ME TO.
AND KEEP OFFER THE FADE BY
THANK THANK YOU VERY MUCH. NEXT
CALLER PLEASE. THANK YOU AND
THAT COMES FROM LINE EIGHTY
FOUR PLEASE GO AHEAD. GOOD
EVENING MEMBERS OF THE
COMMITTEE THIS IS CHRIS AND I'M
BACK WITH THE CALIFORNIA
PARTNERSHIPS AND DOMESTIC
VIOLENCE JUST WANTED TO THANK
YOU ALL FOR HAVING THE HEARING
ON THE IMPORTANCE OF HELLO
HELLO. MANY SURVIVORS OF
DOMESTIC VIOLENCE HELLO HEALTH
OPTIONS HAVE BEEN A REAL
LIFELINE TO REINFORCE THOSE A
PART DURING THE TIME IN
PARTICULAR AS SURVIVORS ARE
SHELTERING AT HOME AND MAY BE
IN A HOME OR WITH THEIR
CHILDREN AND PERHAPS. THE
PERSON WHO IS. NEW CALL FROM
AND VIOLENCE WITH THE GUN FUN.
THE BILL WOULD BE TO RE OUT FOR
SUPPORT BE A- OR VIA CALL- AND
PROVIDE THAT ACCESS WITHOUT
THEM HAVING TO. LEAVE HOME AND
CHILD CARE FOR THEIR KIDS THE
MOTHER OF A PANDEMIC FIND A
REASON OTHER ABUSIVE PARTNER
WILL BECOME A SPECIAL FOCUS ON
MOVING OUT. OF HAVE BEEN A REAL
VITAL RESOURCE BUT HOW CAPS
THEIR FIBERS CONNECTED TO THE
CARE. THEY NEED. I REALLY WANNA
APPRECIATE YOU ALL FOR RAISING
THE IMPORTANT ISSUE AND
CONTINUING THE DISCUSSION ABOUT
HOW WE CONTINUE TO PROVIDE
SUPPORT- THE PEOPLE IN NEED OF
THE- PHONE AND VIDEO AND ALL
PARTS. OF OPTIONS THANK YOU.
THANK YOU VERY MUCH. OUR NEXT
CALLER PLEASE. I HAVE NO ONE
ELSE IN Q. PLEASE CONTINUE
OKAY. THANK YOU VERY MUCH WITH
THAT WILL CLOSE OUR PUBLIC
COMMENT BRING IT BACK- DO YOU
HAVE ANY CLOSING COMMENTS- MISS
AGUIAR-CURRY. OKAY I DO HAVE A
COUPLE CLOSING COMMENTS AND-
AFTER LISTENING TO PUBLIC
COMMENT I FEEL LIKE I NEED TO
CLARIFY A COUPLE OF THINGS
FIRST OF ALL- I HAVE BEEN ALL
ABOUT ACCESS TO CARE IN MY
ENTIRE CAREER HERE AS A MATTER
OF FACT ACCESS TO CARE IN MY
ENTIRE CAREER IN MEDICAL
PROCTOR DENTAL PRACTICE- I DO
BELIEVE THERE. IS ABSOLUTELY OF
VALUE FOR TELEPHONIC CARE.
WHERE I HACKED HAVE HEARTBURN
QUITE FRANKLY IS THE RATE OF
WHICH WE WHAT MIGHT PAY FOR A
TELEPHONIC CARE YOU HEARD FROM
DEPARTMENT HEALTHCARE SRVICES
THAT CURRENTLY UNDER FEDERAL
LAW- A VISIT FOR AN FQHC WOULD
HAVE TO BE REIMBURSED AT THE
PPS RATE. SO AS I SAID EARLIER
PPS RATES RANGE FROM SIXTY
THREE DOLLARS AND SIXTY NINE
CENTS. TO SEVEN HUNDRED AND
EIGHTEEN DOLLARS AND SIXTY
SEVEN CENTS SERVICE. I CAN'T
JUSTIFY A SEVEN HUNDRED DOLLAR
PHONE CALL I'M SORRY I CAN'T I
CAN'T DO THAT ME TELL YOU WHY.
IT FEELS LIKE WE WILL BE OVER
FINDING A LESS EXPENSIVE
MODALITY FOR PROVIDING CARE.
WHEN I PRACTICE DENTISTRY WHICH
IS BEEN A WHILE NOW- A PATIENT
WOULD COME INTO MY OFFICE THEY
WOULDCOME INTO THEY WOULD
REGRET REGRET MY RECEPTIONIST
THEY WOULD BE SEATED BY MY
ASSISTANT. THAT WOULD TAKE UP-
THE ROOM THERE WAS PERSONAL
PROTECTIVE EQUIPMENT INVOLVED
THERE WAS A FACILITY INVOLVED.
AND THERE ARE HARD COST TO THAT.
WITH A TELEPHONE VISIT. THERE
IS NO COST- NONE OF THOSE COSTS
ARE INCURRED THERE IS NO
RECEPTIONIST THERE IS NO
SUPPORT STAFF THERE IS NO
MEDICAL STAFF THERE'S NO PP
BECAUSE THERE IS NOTHING. THERE
EXCEPT THE TELEPHONE WHICH
ALREADY EXISTS IN EVERY FQHC IN
THE IN THE STATE. SO THE IDEA
THAT PARITY AT PPS SIMPLY JUST
DOESN'T MAKE SENSE TO ME AND- I
YOU KNOW THE ADMINISTRATION IS
ADVANCING TELEHEALTH IN A WAY.
OF IN IN A SIGNIFICANT WAY-
POSTS AND THEY'RE PROPOSING
THAT POST FROM THE PRE
PANDEMIC- STATE THAT WE'RE IN.
THIS TO ME BAGS OF A VISIT BACK
TO AN ALTERNATIVE PAYMENT
MODELS SO THAT WE ARE NOT
BREAKING THE BANK POTENTIALLY-
WITH THE MODALITY THAT IS LESS
EXPENSIVE TO PROVIDE SO- JUST
WANNA BE CLEAR I ABSOLUTELY SEE
THE VALUE OF A PHONE VISIT-
AND- I JUST AND STRUGGLING WITH
THE COSTS- WE ARE STRUGGLING IN
THIS STATE- AROUND THE COST TO
PROVIDE CARE. WE HAVE NEARLY
FOURTEEN MILLION PEOPLE ON
MEDICARE. AND AND COST CONTROL
COST CONTROLS AND COST
CONTAINMENT HAVE TO BE A PART
OF THE DISCUSSION SO. I WANT TO
THANK EVERYBODY FOR THEIR-
COMMENTS HERE TODAY I LOOK
FORWARD TO CONTINUING TO TALK
ABOUT THIS AS WE GO FORWARD.
AND I WISH YOU ALL A GOOD
EVENING THANK YOU VERY MUCH.