April 24, 2021

Project Assignment #4

Kenneth Callum, Rana Farran, Eric Tan, & Jazmine Quiralte

MANA 5395 – Formulating & Implementing Strategy

April 24, 2021

The Regulation of Teladoc Health and Telemedicine

Opening

Throughout the course of history, the evolution of medicine has continued to unveil

revolutionary discoveries and life changing practices. Of the many practices discovered,

telemedicine has revolutionized and completely changed the modern world of medicine. In

unique times such as the ones we’re currently experiencing due to COVID-19, Teladoc Health

delivers virtual care and expert medical services for consumers remotely and safely. Teladoc

collaborates with over 50 health plans in the United States as telemedicine becomes more

popular and accessible throughout the country. Since telemedicine is still a fairly new form of

medical treatment, there are issues, such as licensing and regulation, that are present.

Background (Eric)

Telemedicine is the practice of using technology by a medical professional to treat and diagnose

patients in a remote location. In a world that is constantly growing and adjusting to handle the

current pandemic, telemedicine is a field that could take advantage and see incredible growth and

success in the nearby future. The fields biggest barriers in the past 50 years have come from

technological and regulatory challenges. Teladoc Health primarily uses mobile apps to deliver on

demand remote medical service. The main resources the company uses are a number of medical

consultation firms it has acquired. Through the use of its mobile application platform the

company is able to provide remote medical services all over the world. Teladoc currently has

around 15 million members and 6,000 employer clients. The company’s primary form of access

for users is in the form of its mobile application. It provides the user access to a board-certified

doctor 24 hours, 7 days a week, 365 days a year. Teladoc was founded in Dallas, Texas back in

2002 and is now the world’s largest virtual healthcare provider. The company operates in over

170 countries and provides a number of different services that include, AI analytics, telehealth,

medical consultations and virtual care programs. Teladoc has over 50 million members and

12,000 clients and continues to grow rapidly as the current biggest telemedicine service [1].

Showing the full potential, the field of telemedicine could provide in remote locations of the

world or to those with less resources.

Teladoc and the field of telemedicine have seen a dramatic increase during the current

COVID-19 pandemic. Before telemedicine was seen as a largely underutilized sector compared

to traditional healthcare but that quickly changed after the pandemic. During a time, full of social

distancing and quarantining the practice of telemedicine was vaulted right into the spotlight and

is now experiencing tremendous growth [2]. The pandemic has helped accelerate the growth of

digital health technology and now it is up to industry leaders like Teladoc to pave a future where

telemedicine can take advantage of the situation it has been gifted. Since telemedicine is still a

fairly new health field there are some issues and disadvantages Teladoc must deal with.

Licensing and regulation issues are present due to state laws varying. There is also an inability to

closely examine patients or provide assistance in emergency situations. Insurance coverage can

also be an issue since many due to varying state laws and constant law changes. The biggest

challenges Teladoc will need to undergo involve telemedicine licensure reform.

The global health sector is gradually becoming digital and despite the few companies that made

use of telemedicine in the past. Disparate regulatory regimes have posed a difficult situation for

facilities to offer digital services. To be successful and sustainable, telemedicine must be fully

integrated into existing health structures and processes in a practical and policy manner.

Integration can be achieved through aligning telemedicine initiatives with existing strategic

health plans, policy goal setting, accompanying action steps, and attention to policy barriers.

Establishment of a policy forum that focuses on telemedicine policy would facilitate these needs.

Telemedicine policies should incorporate capacity for education, research, and administrative

functions, as well as healthcare functions. The government should adopt the standards for IT in

health structure, format, content, security, transport, and provider identification to improve

interoperability at a nationwide level. The transport model taken by the government should

involve doing away with infrastructure and relying on a wireless connection. The government

should provide financial support for IT projects that fuel development interoperability. The

authorities should eliminate regulations that hinder interoperability and let the market forces in

the nation drive it to development.

Teladoc should start lobbying efforts to start a uniform 50 state telemedicine regulation regime to

include licensure. This effort will allow Teledoc to continue its strategy in providing virtual care

to its 8-million-member coast to coast and spare them from the different regulations that change

from state to state in this country [3]. COVID-19 has stimulated the growth of Teladoc and other

telehealth organizations to push for remote care to minimize contact and stop the spread of the

virus. Unfortunately, if a physician is conducting a virtual appointment with a patient located in

Maryland, that physician has to also be licensed in Maryland to see the patient virtually. The

Centers for Medicare and Medicaid services (CMS) expanded coverage to telehealth services in

March of 2020, lifting many restrictions on the use of telemedicine [4]. Payment policies were

updated and now physicians can bill at the same rate as in person encounters for their virtual

encounters. Telemedicine licensure reform is necessary at this time due to telemedicine being

able to reach larger markets past state borders. The reform should go to the federal level. On the

state level, there has been a growing concern that board members engage in malicious activities

trying to protect their interests and prevent competition instead of serving for the public’s

interest. The federal government could encourage some form of a mutual benefit where all states

automatically recognize an out of state license. This has already been achieved with the Veterna

Affairs (VA) and can be expanded. Another option is the government can issue a national or

federal license to practice medicine in general. Some ways to implement such a reform would be

through Medicare where physicians provide telemedicine services to Medicare recipients in any

state, as long as they possess a medical license which will encourage reciprocity among states.

The federal government can even make it mandatory by a certain date similar to how electronic

health records were made mandatory or similar to how they have dealt with the VA. Something

like this could take months or even years to implement.

Framing (Kenneth)

Leaders of Teladoc definitely possess exceptional skills and competencies which enabled them to

make the company who they’ve become today as one of the top Telemedicine providers in the

world. Teladocs alignment supports its strategy if one considers the 7S model of organizational

alignment but in this case Teladoc should take things a step further. Facing barriers that has been

an ongoing issue for them. Teladoc also has many rivals who are growing in the same market

which can affect their competitive advantage in the future. These barriers can affect their number

one resource, their subscribers. Due to the COVID-19 crisis, most people seeking health care

have had no choice but to turn to telemedicine but companies like Teladoc who provide that

service have had to face barriers reaching communities because of the states.

Take for example physicians cannot treat a patient that is located in a different state where they

are not licensed in. To address this some physicians are licensed in multiple states so they can

practice telemedicine. Some states have temporary licenses that allow telehealth services to be

provided for a short period of time. Then another obstacle Teladoc has to deal with is some states

have a telehealth license that they issue to physicians. The telehealth license is not a real solution

because all states are not in agreement with it. Also potential patients are extremely mobile and

have the capability to move from state to state frequently due to their jobs or personal reasons.

This activity causes Teladoc to face insurer constraints, where the insurer won’t cover some bills

if it’s out of state, due to different state to state laws on medical coverage. That patient would

have to go back to where they are covered to get the help or medical service they need even if

they were seeing a patient via Teladoc. These kinds of issues differ from state to state and the

laws keep changing. Maybe Teladoc can change them in a way to where they work in their favor.

Conclusion (Jazmine)

Often this section will circle back to the beginning of the case by focusing on the protagonist

described in the introduction. It may be appropriate to remind our readers one more time of the

primary problem or issue and the specific decision that needs to be addressed.

References

1. Thomas, Dr. Liji. “What Is Telemedicine?” News, 17 Mar. 2021,

www.news-medical.net/health/What-is-Telemedicine.aspx.

2. Allison Marin Nov. 6, 2020. “Telemedicine Takes Center Stage in the Era of COVID-19.”

Science, 5 Nov. 2020,

www.sciencemag.org/features/2020/11/telemedicine-takes-center-stage-era-covid-19.

http://www.sciencemag.org/features/2020/11/telemedicine-takes-center-stage-era-covid-19

http://www.sciencemag.org/features/2020/11/telemedicine-takes-center-stage-era-covid-19

3. Brailer, D.J., 2005. Interoperability: the key to the future health care system. Health affairs, 24,

p.W5.

4. Damisch, Marcie M. 2018. “Telemedicine Licensure and Related Challenges for Physicians.”

Medical Economics 95