delivery system. But clinicians quickly dusted off their webcams and leveraged telehealth to continue care—and keep their practices afloat—while still meeting social distancing guidelines. Temporary, dramatic policy waivers (see box) broadened access to and payment for telehealth on an unprecedented scale. These policy changes led to skyrocketing telehealth use in spring 2020. At the time, there was a lot of talk about how telehealth’s time had finally arrived, and how genies were not returning to their bottles. But that might be the wrong metaphor for telehealth use in 2020. The surge in telehealth use had ebbed somewhat by the summer months (Mehrotra et al., 2020), and it is too soon to tell whether the initial enthusiasm for virtual visits was borne of desperation (Uscher-Pines, 2020) or whether some of the newfound appreciation for telehealth can persist under the right policy conditions. LORI USCHER-PINES, MONIQUE MARTINEAU Telehealth After COVID-19 Clarifying Policy Goals for a Way Forward C O R P O R A T I O N Perspective EXPERT INSIGHTS ON A TIMELY POLICY ISSUE January 2021 2 Many telehealth advocacy organizations, medical professional organizations, and patients support the policy shifts toward greater telehealth access that have been made during the pandemic and have been urging policymakers to make many of the temporary changes permanent after the pandemic ends. They argue that telehealth should continue to serve patients located in their homes or workplaces in all communities in the United States, and Federal Telehealth Restrictions Temporarily Changed During the Public Health Emergency and Responsible Agency or Legislation Medicare • Expand the types of providers that can furnish and are eligible to bill Medicare for telehealth services (Coronavirus Aid, Relief, and Economic Security [CARES] Act) • Allow providers eligible to bill Medicare to offer services to both new and established patients inside their homes, including across state lines (Centers for Medicare & Medicaid Services [CMS]) • Allow supervision of services through audio and video communication (CMS) • Waive requirement for the use of video technology to enable use of audio-only communication for certain Medicare services (CARES Act) • Allow Federally Qualified Health Centers (FQHCs) and rural health clinics to provide telehealth services where patients are located, including home (CARES Act) Controlled Substances • Permit qualified practitioners to use a telephone or video evaluation as a basis to prescribe buprenorphine to new and existing patients (Drug Enforcement Administration [DEA]) Technology • Waive requirement that communications platforms be Health Insurance Portability and Accountability Act (HIPAA)– compliant, as long as they are non-public facing, allowing telehealth to take place over consumer-friendly platforms (e.g., Apple’s FaceTime) (U.S. Department of Health and Human Services [HHS] Office of Civil Rights) Cost Sharing • Waive administrative sanctions for providers who reduce or waive cost sharing (e.g., copayment, coinsurance), for telehealth services paid for by federal or state health care programs like Medicare or Medicaid (HHS Office of the Inspector General) In addition, most states have modified their requirements for telehealth services provided from out of state. SOURCES: Centers for Medicare & Medicaid Services (CMS), 2020; Health Resources and Service Administration, 2020; and Pub. L. 116-136, 2020. 3 that reimbursement for telehealth should be equivalent to in-person visits. Many payers and policymakers agree that telehealth has value and is a promising tool and some have signaled interest in extending certain changes. Yet they also worry about escalating costs and the potential for fraud and abuse, which were prime concerns that guided pre-pandemic policy. In fact, many of the prior restrictions on the provision of telehealth services were grounded in the assumption that telehealth’s convenience would lead to overutilization and that allowing too much flexibility in reimbursable forms of telehealth would cause costs to soar. The pandemic sidelined cost concerns, but the desire to contain telehealth costs has started to reemerge: Some payers have started to roll back cost-sharing waivers and have indicated that the days of reimbursement for audioonly visits are numbered. At least some types of telehealth are going to be wrangled back into the bottle, in lockdown like the rest of us. Though the pandemic continues, policymakers will need to make some key decisJons and set priorities about telehealth policy going forward. In this Perspective, we consider a number of possible telehealth policy goals and the evidence for each that has accumulated over the years. We end with recommendations for how policymakers might use the full range of tools at their disposal to craft targeted policies to achieve their desired goals. The Policy Triumvirate When considering a new policy or intervention, it is standard to explore whether it is likely to improve quality, reduce costs, improve access, or achieve some combination of these goals. A complex challenge with telehealth is that it is not a monolith; telehealth can take many different forms (Figure 1) and it is far better suited to some use cases (e.g., ongoing psychotherapy for a patient with mental illness,