In 2020, Alaska temporarily allowed some health care practitioners with out-of-state licenses to provide telehealth services to Alaskans in response to the COVID-19 crisis. In 2022, policymakers passed legislation making some of the temporary allowances from the COVID-19 pandemic permanent. More still needs to be done, however, to increase access to telehealth, as Alaskans deserve timely, affordable health care even when a pandemic is not occurring.
New research published by the Reason Foundation examines four areas important for expansive telehealth policy, and compares each state to assess current performance and opportunities for improvement. The report rates each state either green (the laws are clear and comprehensive), yellow (the laws could use some improvement), or red (the laws need quite a bit of improvement) for each of the four areas, which are:
Patients Can Access all Forms of Telehealth
Telehealth is possible through more than just a phone call or live video call between a provider and a patient. The authors of the report, Josh Archambault and Vittorio Nastasi, highlight a “modality-neutral” definition of telehealth to include both asynchronous or synchronous methods (communication with a lag between replies, or real-time communication), that use a variety of technologies such as audio-video, store-and-forward, or remote patient monitoring.
Store-and-forward care could be something like sending a photo of a rash to a dermatologist, who replies at a different time. Remote patient monitoring uses technologies to monitor and transmit personal health data, which allows many patients to be monitored without leaving the comfort of their homes.
Alaska is rated yellow in this category: the state “allows synchronous and asynchronous explicitly or has a broad enough definition to allow its use.” However, states with a green rating also have laws that specifically mention store-and-forward and remote patient monitoring.
Patients Can Start a Telehealth Relationship by Any Mode
Some states, including Alaska, allow both synchronous and asynchronous modalities in telehealth as seen in the map above, but may limit which can be used to begin a patient-provider relationship. Alaska law requires that these relationships begin only in person, giving the state another yellow rating. Archambault and Nastasi recommend “remov[ing] barriers that get in the way of jump-starting a telehealth relationship,” such as in-person requirements.
The authors explain that “every patient has a different preference for how to interact with a telehealth provider. As a result, allowing for the relationship to be initiated through the patient’s preferred modality is imperative. Imagine someone experiencing a behavioral health crisis in the middle of the night. They might strongly prefer to start communication by text or in an asynchronous manner before being comfortable switching to a video call or in-person visit.”
Reason Foundation, “State Policy Agenda for Telehealth Innovation”
Patients Face No Barriers to Accessing Telehealth Across State Lines
Patients across the nation need access to providers and specialists outside their communities—and particularly in Alaska, they need access to those outside the state. For many Alaskans, telehealth or flying out of state are the only options for access to specialists, second opinions, or team-based care. Besides the cost and time it takes to travel out of state, regularly traveling long distances to see their providers is not conducive to many patients’ health. As Archambault and Nastasi explain, “allowing across-state-line telehealth ends geographic and economic discrimination for many patients and allows access to providers who would not otherwise be accessible by distance or expense of travel.”
The authors classify Alaska as yellow, with “a clear, straightforward, predictable registration or licensing process” that unfortunately “only applies to physicians or certain kinds of providers.” Green states have clear registration and licensing processes “for all out-of-state health care providers to see patients across state lines.” Alaskans would benefit from all licensed medical practitioners in good standing in other states having the ability to practice telemedicine here.
Independent Practice
In this report, independent practice refers specifically to the ability of nurse practitioners (NPs) to practice to the full extent of their training, or if they must, have the oversight/co-signing of a doctor. Alaska, mirroring the rest of the nation, has a shortage of doctors; allowing NPs to practice independently increases Alaskans’ health care access. In fact, research shows that expanding NPs’ scope of practice also reduces health care costs.
In this category, Alaska is given a green rating, because “NPs can practice independently without a collaborative practice agreement or supervision from a physician to provide medical services.”
Alaskans’ access to telehealth is certainly not the worst in the nation, but it could be better. More expansive telehealth policies that encompass the green ratings above, such as modality-neutral regulations, increased ability to begin a patient-provider relationship asynchronously, and allowing all types of licensed providers in good standing from other states to practice in Alaska would benefit the state.
Expanding telehealth in Alaska would improve health outcomes, increase access to care, and reduce health care costs. Alaskans deserve to be healthy, and telehealth is the future of health care. Alaska should strive to be at the forefront of that now.