Alliance Statement on Cross-State Licensure in SOTU
We are grateful to President Biden for highlighting the pressing issue of cross-state licensure in advance of the State of the Union. The pandemic taught us that it is possible, and safe, to allow providers to treat patients anywhere. State borders should cease to be an artificial barrier to health care. It’s time to change the cumbersome, time-consuming, expensive, and duplicative licensing rules that prevent patients from receiving care from qualified, licensed providers in other states.
We would miss an opportunity if we approach this issue incrementally. Allowing cross-state treatment for one patient population or disease-type may have made sense as a first step before the pandemic, but we have had more than two years of access for patients in need of all types of services. We should change the status quo for all patients, regardless of diagnosis.
A Nationwide Telehealth Heart Failure Program: Can Remote Patient Monitoring and Guideline Directed Treatment Protocols Help Bridge the Gaps in Heart Failure Management?
A Nationwide Telehealth Heart Failure Program: Can Remote Patient Monitoring and Guideline Directed Treatment Protocols Help Bridge the Gaps in Heart Failure Management?
Loading...
Reload document 
Open in new tab Alliance Support Letter for Washington SB 5481 – Concerning the Uniform Telehealth Act
The Alliance submitted a letter of support to Annette Cleveland, Chair of the Senate Health & Long Term Care Committee within the Washington State Legislature, for Senate Bill 5481 – Concerning the Uniform Telemedicine Act.
The bill would adopt the Uniform Telemedicine Act in the State of Washington. The Uniform Telemedicine Act would provide the state with the clear guidance and framework needed to facilitate the delivery of services via telehealth consistent with the standard of care of the state in which the patient is located. It would also establish a registration system for out-of-state practitioners to provide telehealth services to patients located in the state adopting this Act, therefore enabling practitioners to provide widespread assistance to patients in a more convenient and cost-effective manner.
This bill would be a foundational first step to better facilitate the delivery of telehealth services and address the patchwork of licensure laws that exist from state to state to ensure patients can continue to be at the center of their care.
Read the full letter here and below:
Loading...
Alliance Submits Comments in Response to White House OSTP on Clinical Research Infrastructure and Emergency Clinical Trials
Share:
The Alliance for Connected Care submitted comments in response to the request for information from the White House Office of Science and Technology Policy (OSTP) on clinical research infrastructure and emergency clinical trials .
The Alliance specifically outlined licensure restrictions that present a barrier to clinical trial recruitment and diversity and
present a recommendation for OSTP’s consideration.
As one goal of this emergency clinical trials initiative is to support the expansion of clinical research into underserved communities, and increase diversity among both trial participants and clinical trial investigators, the Alliance believes that continuing to modernize and decentralize clinical trials is critical for creating opportunities for more diversity and patient engagement.
To read the full letter, click here or see below:
Loading...
Letter to MACs About RPM Meeting
The Alliance for Connected Care joined a letter, led by the Connected Health Initiative (CHI).
Loading...
Alliance Urges CMS to Preserve Beneficiary Access to Telehealth Services
Action Needed to Align Payment with Congressional Authority
On January 13, 2023, the Alliance for Connected Care sent a letter to the Centers for Medicare & Medicaid Services (CMS) regarding the implementation of the telehealth provisions in the Consolidated Appropriations Act, 2023.
Some Medicare telehealth codes are currently scheduled to expire 151 days after the expiration of the COVID-19 public health emergency (PHE). While most telehealth codes can simply be extended in the annual calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) rulemaking, the timeline is too rapid to address the issue.
The Alliance requests that CMS issue an interim final rule to implement the date changes as per the Consolidated Appropriations Act, 2023.
To read the letter, see below or click here.
Loading...
The Alliance for Connected Care also joined a larger stakeholder letter to CMS to extend the availability of the codes that are temporarily on the Medicare Telehealth Services List to align with the Consolidated Appropriations Act of 2023.
Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial
Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial
Background: The randomized INH (Interdisciplinary Network Heart Failure) trial (N = 715) reported that 6 months’ remote patient management (RPM) (HeartNetCare-HF) did not reduce the primary outcome (time to all-cause death/rehospitalization) vs usual care (UC) in patients discharged after admission for acute heart failure, but suggested lower mortality and better quality of life in the RPM group.
Objectives: The Extended (E)-INH trial investigated the effects of 18 months’ HeartNetCare-HF on the same primary outcome in an expanded population (N = 1,022) and followed survivors up to 60 months (primary outcome events) or up to 120 months (mortality) after RPM termination.
Methods: Eligible patients aged ≥18 years, hospitalized for acute heart failure, and with predischarge ejection fraction ≤40% were randomized to RPM (RPM+UC; n = 509) or control (UC; n = 513). Follow-up visits were every 6 months during RPM, and then at 36, 60, and 120 months.
Results: The primary outcome did not differ between groups at 18 months (60.7% [95% CI: 56.5%-65.0%] vs 61.2% [95% CI: 57.0%-65.4%]) or 60 months (78.1% [95% CI: 74.4%-81.6%] vs 82.8% [95% CI: 79.5%-86.0%]). At 60 and 120 months, all-cause mortality was lower in patients previously undergoing RPM (41.1% [95% CI: 37.0%-45.5%] vs 47.4% [95% CI: 43.2%-51.8%]; P = 0.040 and 64.0% [95% CI: 59.8%-68.2%] vs 69.6% [95% CI: 65.6%-73.5%]; P = 0.019). At all visits, health-related quality of life was better in patients exposed to HeartNetCare-HF vs UC.
Conclusions: Although 18 months’ HeartNetCare-HF did not significantly reduce the primary outcome of death or rehospitalization at 60 months, lower 120-month mortality in patients previously undergoing HeartNetCare-HF suggested beneficial longer-term effects, although the possibility of a chance finding remains.
Alliance for Connected Care Executive Director Featured in The Hill
Share:
Krista Drobac, executive director of the Alliance for Connected Care, was featured in The Hill.
See below for an excerpt:
Clock is still ticking on virtual mental health prescribing
Congress acted last month to extend important telehealth flexibilities that will ensure millions of Americans and their providers will continue to have access to telehealth when the COVID-19 public health emergency is officially over. The importance of these policy extensions can’t be overstated. However, there is one remaining critical action item: prescribing for mental health and substance abuse treatment.
Read the full article here.
For more information about the Alliance’s advocacy in this area, see here.
Top Accomplishments 2022
Share:
Building off of the transformation of telehealth access since 2020, the Alliance has continued to drive the advocacy steps needed for permanent telehealth expansion. We are excited to successfully hold on to important expansions and continue progress in 2023.
Alliance Top Accomplishments
1 A temporary two-year extension of all Medicare telehealth in the fiscal year (FY) 2023 Omnibus Appropriations bill was a major Alliance accomplishment. The Alliance has been calling for a two-year extension since 2021 – citing the need to create for predictability for patients and clinicians while we continue to work toward permanent telehealth authorization.
- The Alliance lobbied heavily for this expansion, led numerous advocacy letters with hundreds of signers, and most importantly – built the evidence base needed to support policy action.
- Notably, this expansion also includes a two-year delay of patient-harming in-person requirements on mental health in Medicare.
- On top of all this – it was the second legislative extension this year, expanding upon the short-term extension we secured in the spring of 2022.
2 A crucial two-year extension of commercial market telehealth flexibilities for individuals and families with high deductible health plans coupled with a health savings accounts (HDHP-HSA) allowing employers and health plans have to provide pre-deductible coverage of telehealth services. This policy is a game changer for the 32 million Americans who would otherwise have to think twice about out-of-pocket costs in accessing care.
- The Alliance led other groups on numerous comment letters, supported Congressional member advocacy letters, and continued to build the evidence base for how these important provisions impact individuals and families.
- Progress in this space is particularly notable because major wins in spring 2022 and December 2022 reversed a failure to extend this policy in December 2021.
3 Major progress in advancing cross-state licensure for telehealth and the need to reform outdated licensure laws that impose barriers in access to care for patients. The Alliance continues to be regularly consulted as an authority on these challenges and opportunities to advance them.
- The Alliance helped drive forward a new Model Telehealth Law with the Uniform Law Commission telehealth working group, which published its Uniform Telehealth Act in July 2022.
- The Alliance actively supported a number of state legislative initiatives and made headway on related areas, such as ensuring clinical trials are able to be managed across state lines – which is now recognized as an important access exception by the Federation of State Medical Boards. We are looking forward to significant new wins in 2023.
See here or below for the Alliance’s top accomplishments in 2022.
The Alliance’s expertise was quoted on average of
1.3
times per week
Loading...
Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF)
Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF)
Background: Guidelines recommend early initiation of multiple guideline-directed medical therapies (GDMTs) to reduce mortality/rehospitalization in patients with heart failure and reduced ejection fraction. Understanding GDMT use is critical to improving clinical practice.
Objectives: This study sought to describe GDMT use in Japan, Sweden, and the United States in contemporary real-world settings.
Methods: EVOLUTION HF (Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients: A Multinational Observational Study Based on Secondary Data) is an observational cohort study using routine-care databases. Patients initiating any GDMT within 12 months of a hospitalization for heart failure (hHF) discharge were included. Dapagliflozin (the only sodium-glucose cotransporter-2 inhibitor approved at study onset), sacubitril/valsartan, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) were considered separately. Doses and discontinuation were assessed in the 12 months following initiation. Target dose was defined as ≥100% of the guideline-recommended dose.
Results: Overall, 266,589 patients were included. Mean times from hHF to GDMT initiation were longer for novel GDMTs (dapagliflozin or sacubitril/valsartan) than for other GDMTs: 39 and 44 vs 12 to 13 days (Japan), 44 and 33 vs 22 to 31 days (Sweden), and 33 and 19 vs 18 to 24 days (United States). Pooled across countries, proportions of patients who discontinued therapy (not including switches from ACE inhibitor or ARB to sacubitril/valsartan) within 12 months were 23.5% (dapagliflozin), 26.4% (sacubitril/valsartan), 38.4% (ACE inhibitors), 33.4% (ARBs), 25.2% (beta-blockers), and 42.2% (MRAs). Corresponding target dose achievements were 75.7%, 28.2%, 20.1%, 6.7%, 7.2%, and 5.1%, respectively.
Conclusions: Initiation of novel GDMTs is delayed compared with other GDMTs. Few patients received target doses of GDMTs requiring uptitration. Persistence was higher for dapagliflozin than other GDMTs.