Telehealth: from emergency fix to mainstream care
Telehealth moved from an emergency workaround to a core part of care delivery.
Policymakers are grappling with how to make telehealth sustainable while ensuring quality and equity. Key policy levers include payment parity, interstate licensure, broadband investment, and privacy standards. Reimbursing telehealth at sustainable rates encourages providers to offer virtual visits for primary care, behavioral health, and chronic disease management.
Expanding interstate licensure compacts and standardizing telehealth rules across states reduces administrative burden and improves access for rural and underserved populations. Closing the digital divide through targeted broadband funding is essential to prevent telehealth from widening disparities.
Prescription drugs: pricing transparency and negotiation
Prescription drug affordability remains a top concern. Current policy debates focus on pricing transparency, reforming pharmacy benefit manager (PBM) practices, and expanding negotiation authority for large public payers.
Measures that increase competition, limit excessive rebates, and require clear out-of-pocket cost information at the point of sale can lower patient expenses.
Encouraging use of generics and biosimilars, coupled with targeted negotiation for high-cost therapies, aligns incentives toward value without stifling innovation.
Medicare and Medicaid: access, long-term care, and payment models
Medicare and Medicaid continue to be central to access and cost containment. Policymakers are exploring value-based payment models that reward outcomes over volume, while protecting beneficiaries from coverage gaps. Medicaid plays a critical role in long-term services and supports; expanding home- and community-based services reduces institutional care costs and improves quality of life.
State decisions around Medicaid expansion and program design have a major impact on coverage gaps and health equity.
Behavioral health and workforce capacity
Behavioral health policy is shifting toward integrated, whole-person care. Expanding parity enforcement, increasing reimbursement for behavioral health services, and integrating behavioral health into primary care are priorities.
Workforce shortages are a persistent barrier; policy solutions include loan forgiveness for clinicians in underserved areas, expanded training for community health workers, and streamlined licensing for qualified practitioners across state lines.
Addressing social determinants of health
Payors and health systems increasingly recognize that housing, food security, transportation, and other social needs drive health outcomes. Innovative payment models now allow funds to be directed toward nonmedical supports when evidence shows a return on health and cost outcomes. Scaling proven interventions requires clear metrics, cross-sector partnerships, and flexible funding mechanisms.
Policy recommendations for stakeholders
– Prioritize broadband and telehealth infrastructure to ensure equitable virtual access.
– Promote payment models that reward value and integration of behavioral health and social services.
– Increase transparency in drug pricing and PBM practices to lower out-of-pocket costs.
– Support workforce incentives and interstate licensing reforms to expand access.
– Invest in data interoperability and standardized measures to track outcomes and equity.
Health policy is shifting toward models that link payment to outcomes, remove barriers to access, and address the social context of health. Policymakers who focus on evidence-based reforms, cross-sector collaboration, and targeted investments can improve care quality while containing costs, creating a more resilient and equitable system for all.