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Telehealth

Maia Anderson

Healthcare Brew delivers the latest news and trends in healthcare.

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 by the Covid-19 pandemic, tech industry veteran Bismarck Lepe co-founded a startup tailored specifically to the community, called MiSalud Health. 

The company offers Spanish-speaking people living in the US telehealth visits with health coaches in Mexico who offer a range of primary care and behavioral health services.

MiSalud has raised nearly $19 million through venture capital funding from investors including Ulu Ventures, Pivotal Ventures, and Magnify Ventures, according to Lepe. It employs 50 clinicians in Mexico, 23 clinicians in the US, and operates across 16 states.

Healthcare Brew spoke to Lepe about MiSalud’s business model, how the company is incorporating technology into care, and his hopes for the startup’s future.

This interview has been edited for length and clarity.

 from Covid, more likely to be hospitalized, and 

 to get it. We dug into that issue and we realized that it was an access issue. Many Hispanics live in 

. We thought, “Maybe we can tap into physicians in Mexico, and through technology, be able to give people in the US access to those physicians.”

We got the company started in 2021, and it’s scaled very nicely. We’re approaching 100,000 members on the platform. We primarily sell directly to employers who have a high concentration of Spanish speakers, but about 30% of our consults are done in English.

Our mission is to make healthcare more accessible and affordable for everybody. We are starting with the Hispanic population because they’re more receptive to speaking to a health coach that may be based in Mexico, and there’s an immediate need in terms of language gaps and cultural gaps. We think this near-shore model in healthcare can work for everybody.

How do patients get set up with MiSalud, and what services do you offer?

When we start with an employer, we’ll go [to their worksite] and do biometrics tests, blood draws, get people’s weight, get their BMI, and then put them in specific programs. If their goal is to lower their diabetes or if they have hypertension, they’re put into specific programs, then they meet with their health coach on a regular basis.

We have about 90% participation. If we go to a factory that has 1,000 employees, 900 will participate in the initial wellness fair. Of those, about 50% use the platform on a recurring basis.

MiSalud covers many different services, and in some cases it does step in as an alternative to a primary care provider (PCP). Sometimes we have to refer people out to go get labs done, to go get imaging, to potentially go see their PCP. We will also do some care navigation, especially if someone doesn’t understand what their insurance covers.

We’ve created our own healthcare copilots that sit alongside our health coaches and our physicians. They’re taking notes and summarizing what’s been said so it’s much faster to figure out what the person may need.

As the visits are happening, our copilots are making recommendations to the health coaches or the physicians, and when they disagree, they’ll very quickly say so, providing reinforcement learning to our AI. The goal is eventually to be able to release some of this functionality to our end users. One of the first versions of this that we’re going to be releasing is a nutrition app that’s been trained through the many thousands of nutrition consults and visits we’ve had across our platform, and that’s going to be released sometime in the near future.

What are your future goals for the company?

We want to continue to add more specialties. We’re adding women’s health and pediatrics. The key is going to be really personalizing the experience for everybody who logs in. If you have a universe of potential services that you can offer, you want to make sure that the services are being catered to the individual. We want to continue to invest in our AI agents so eventually we have a MiSalud agent that’s really monitoring and managing your health and brings in the specialist whenever they’re required.

Eventually we think there may be an opportunity for us to have clinical laboratories in places where we already have a high concentration of members, or maybe even start with our own hospitals and clinics on the other side of the border and start to build more of a holistic health system under the MiSalud brand.

A portrait of co-founder and CEO of MiSalud Health, Bismarck Lepe

How MiSalud Health tailors care to the Hispanic population 

The telehealth company offers a range of primary care and behavioral health services. 

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

As of 12:01 Wednesday morning, the US government has shut down.

The shutdown, the first since 2018, came about because congressional Democrats and Republicans 

 on a spending bill. A key line in the sand: Democratic leaders want to 

 2021 enhanced Affordable Care Act (ACA) premium subsidies while Republican leaders want to allow them to expire at the end of the year.

If they expire, premiums are expected to spike for the 24+ million people enrolled in the 

, and providers are expected to lose billions in revenue, per a recent 

 from nonprofit Robert Wood Johnson Foundation.

In the meantime, as Congress dukes it out, healthcare is going to look a little different.

For one, without a spending plan, several pandemic-era Medicare flexibilities are no longer in effect.

A 2020 waiver allowing hospitals to deliver inpatient care to Medicare patients 

As of July 2025, 400 hospitals across 142 systems and 39 states were approved to provide hospital-at-home services, according to a July American Hospital Association (AHA) fact sheet.

The Centers for Medicare and Medicaid Services (CMS) ordered all hospitals with active waivers to 

their hospital-at-home patients or return them to the hospital on Sept. 30, according to an alert on the agency’s page.

This pause may “hamper long-term progress for the hospital-at-home program,” AHA spokesperson Colin Milligan told Healthcare Brew.

Flexibilities that reimbursed telehealth care for Medicare beneficiaries at their homes regardless of where they lived also expired Oct. 1, despite 

 must take telehealth appointments from locations such as a provider’s office or skilled nursing facility within a rural health professional shortage area, a federal telehealth demonstration project, or in a county that isn’t in a metropolitan statistical area.

Exceptions are made for behavioral health and substance use treatment and for people with some other medical conditions such as kidney failure, according to the Department of Health and Human Services (HHS).

Some providers and hospital systems have reportedly started blocking these patients from scheduling visits, though 

 are still providing telehealth care in the hopes of later retroactive payment, according to an Oct. 1 letter from the American Telemedicine Association’s advocacy arm, ATA Action.

 urged President Trump and Congress to extend the flexibilities and enact a retroactive telehealth reimbursement program so those medical professionals can be reimbursed.

“Medicare patients woke up this morning without telehealth coverage for the first time since the pandemic, five years ago. Our healthcare services are regressing, falling woefully short for millions of patients in need,” Kyle Zebley, executive director of ATA Action and SVP of public policy at ATA, said in an Oct. 1 press release.

 41% (32,460) of staff “as of day two of a funding lapse.” About 59% (47,257) will stay on to conduct essential activities such as monitoring for disease outbreaks, conducting crucial research and clinical tasks, and reviewing drug and medical devices.

Medicare and Medicaid payments will continue, and CMS has enough cash on hand to fund Medicaid through Q1 2026, according to a CMS contingency 

. But some survey activity, contract oversight, and beneficiary casework has been paused.

 new drug applications during the shutdown, according to the agency’s contingency plan.

an illustration of the US Capitol building being unplugged

What a government shutdown means for healthcare

New drug submissions, Medicare coverage of telehealth, and hospital-at-home are all paused. 

Congress is once again closing in on a deadline to extend Medicare coverage of home 

 services. And, again, the decision has been left until the last minute.

Telehealth has had new flexibilities since the 

 public health emergency began, including expanded Medicare reimbursement. Originally scheduled to sunset alongside the emergency’s declared end, these flexibilities have been 

 over and over again, often just weeks before planned expirations hit.

Congress has seen several bipartisan bills ranging from another 

 to even making some Medicare flexibilities for telehealth permanent. The House 

 an extension in a stopgap bill that aimed to avoid a looming government shutdown, but the Senate 

If nothing is passed, on Oct. 1, many Medicare members won’t be able to access telemedicine from their homes anymore.

Even if an extension is passed, this uncertainty still impacts providers’ businesses, leaving them struggling to plan for a potential future where they might lose a chunk of their patients, experts told us.

“For us in the industry, it creates operational and administrative burdens to ensure we are compliant. For patients, the uncertainty creates a lack of trust,” Taya Gordon, CEO of Atlas and Perpetua Healthcare Consulting and government affairs committee member for the professional organization Medical Group Management Association (MGMA), said.

 If the flexibilities go away, most Medicare patients will have to take telehealth appointments from a provider’s office, hospital, or skilled nursing facility. They won’t be able to take calls from home unless they’re getting treatment for mental health or a substance use disorder, or a few other narrow exceptions.

Other restrictions will also come back into play. Telehealth will once again be limited to patients in a rural health professional shortage area, within a federal telehealth demonstration project, or in a county that isn’t in a metropolitan statistical area.

Each time these flexibilities get close to expiring, medical groups must plan how to transition telehealth appointments to in-person appointments and budget for the cost of losing some patients, Anders Gilberg, SVP of government affairs for MGMA, told Healthcare Brew over email.

Amid this repeated “headache,” some providers are “seriously thinking about eliminating” telehealth and remote patient monitoring, Tom Leary, SVP and head of government relations of the Healthcare Information and Management Systems Society, told us.

The end of telehealth flexibilities would also affect a lot of people.

The percent of eligible Medicare beneficiaries getting telehealth services skyrocketed from 6.9% in Q1 2020 to 46.7% the following quarter. It 

, but is still higher than pre-pandemic: In Q4 2023, 12.7% received telehealth care, according to KFF data.

If the flexibilities expire, the rules will largely revert to how they were in March 2020. Those rules existed in a world where there was insufficient data on telehealth outcomes, but over the last five years, telehealth has been proven worthy of broad Medicare coverage, Leary argued.

 in the Cureus Journal of Medical Science found telehealth can improve patient health and save costs while helping patients overcome geographic barriers to care.

“There was [previously] not enough data on telehealth use by Medicare patients to be able to properly do the actuarial work,” Leary said. “That argument is no longer valid.”

A cutout of an older woman checking her blood pressure while on a video call with a doctor on a laptop screen.

Telehealth’s uncertain future has providers preparing for the worst, hoping for the best

Hope you brought some Dramamine because this is a rollercoaster!

AI is hailed by many in healthcare as the future. But some worry as the tech advances, rural areas may get left behind.

A 2025 survey of 972 rural healthcare staff and leaders by independent research firm Black Book Research found just 8% of rural community and critical access hospitals use AI-driven analytics for predictive healthcare. Compare this to an 

 of 2023 American Hospital Association survey data, which found 65% of 2,547 hospitals across the US used AI or other predictive models.

Carrie Cochran-McClain, chief policy officer for the National Rural Health Association, told Healthcare Brew many rural facilities don’t have the funds or infrastructure to adopt AI and other new tech. It’s already a “battle” to help more rural facilities implement telehealth amid interoperability issues and areas without broadband internet, she added.

“About half of our rural hospitals right now in the country have negative operating margins, which means there’s not a cushion to invest in new software,” she said. “We’ve talked to clinicians who are starting to integrate pieces of [AI] and seeing a lot of benefit, but it’s very much still new to that setting.”

 Though AI comes with potential drawbacks—like 

 concerns—studies also suggest predictive analytics can identify high-risk patients for earlier intervention, potentially 

Groups ranging from industry organization the 

 have pointed to AI as a way for rural hospitals to 

About 66% of primary care health professional shortage areas and 62% of mental health shortage areas were in rural regions as of March 31, 

 the Health Resources and Services Administration.

“Clinicians could use AI to help inform their decision-making where they may not have a deep bench of providers in their clinical practice,” Cochran-McClain said.

Rural systems’ low adoption of AI is something Cochran-McClain and other experts hope could soon change.

Though July’s reconciliation bill had provisions that were decried as potential 

 for rural health, it also allocated $50 billion of funds to a newly created Rural Health Transformation Program.

One of the approved uses for these funds is “providing training and technical assistance for the development and adoption of technology-enabled solutions that improve care delivery in rural hospitals,” including AI tools, according to Centers for Medicare and Medicaid Services (CMS).

Cost estimates vary, but California-based software development company Folio3 estimates adding AI can cost anywhere from $40,000 for a simple AI tool to $100,000+ for a fully customized system.

Without a pathway for long-term Medicare and Medicaid reimbursement, however, pouring money into these technologies doesn’t make sense, Cochran-McClain said.

“This funding could be a great way to infuse the startup or implementation of some of these technologies. But there needs to be a sustainable path to support them outside of the transformation fund,” she said.

CMS reimburses some AI devices through mechanisms like the new technology add-on payment 

, which allows payment for recently FDA-approved technology to be bundled with payments for other healthcare services.

But devices are only eligible for that pathway when they’re “new,” usually meaning the first few years after FDA approval. When that period ends, the path to reimbursement can become uncertain, and reimbursement amounts may decrease or go away.

There’s no predictable or permanent AI reimbursement pathway, Cybil Roehrenbeck, a partner at law firm Hogan Lovells who leads the firm’s healthcare lobbying practice and serves as executive director of the AI Healthcare Coalition, told us.

Roehrenbeck wants a pathway for software-as-a-service and AI medical services within the Medicare Physician Fee Schedule. She says they should be categorized as medical services under Medicare Part B and billed, like other services in that category.

CMS noted in its proposed 2026 Physician Fee Schedule that many in the industry have sought a similar pathway, and asked for public comment through Sept. 12.

“It’s easier for providers to onboard the technology with that type of certainty,” Roehrenbeck said.

United States technology modern innovation circuit board computer map shape.

Rural healthcare crosses fingers for AI investment, reimbursement

Rural health systems use less tech than their urban counterparts. Could policy change that?

Nicole Ortiz

Serena Williams is known as many things. The GOAT in tennis. An Olympic gold medalist. A storied athlete and mother. And as of recently, an enthusiastic GLP-1 user.

This recently acquired knowledge is due to the fact that Williams was announced as the new “celebrity patient ambassador” for direct-to-consumer telehealth company Ro on Aug. 21. The goal of this multiyear 

 is to “destigmatize weight loss medication,” Saman Rahmanian, co-founder and chief product officer at Ro, told Healthcare Brew.

Williams was a patient first and then wanted to share her story with others, he added. (Her husband, Alexis Ohanian, who’s also the co-founder of Reddit, is an 

“For us, that’s really the dream, when we have a patient who turns into an advocate,” Rahmanian said. “It gives people the permission to take care of their health and see if [a certain treatment] is right for them.”

While celebrity endorsements in pharmaceutical ads isn’t exactly a new marketing trick, it’s usually seen when that celebrity has a specific condition the drug is treating. Ro’s campaign felt different, Mae Karwowski, founder and CEO of influencer marketing agency Obviously, told us.

“This just felt like it was made for social [media],” she said. “I think it’s a big leap forward for influencer marketing in the pharma space.”

On top of that, she added, it helps Ro stand out in a crowded (and 

) market. Because it isn’t just the drugmakers that stand to benefit from the booming GLP-1 business—which some 

 forecast could reach $95 billion by 2030, and which made up 98% of 

 ($22.4 billion) in 2024—but also the telehealth companies like Ro that sell them.

GLP-1s are one of Ro’s “largest categories” it can provide to its 3+ million customers, Rahmanian said, though the company also has fertility, hair loss, skin, and hair treatment offerings.

This isn’t the first time Ro has used a celebrity athlete as its GLP-1 ambassador: Former NBA player Charles Barkley was announced as one in April. Both Barkley and Williams have been outspoken about struggling to lose weight, which created more “authenticity,” Rahmanian said.

But this campaign with Williams also “sparked a conversation” about 

 Featuring Williams in such a prominent role in a GLP-1 campaign could create more of a trend within the pharmaceutical industry overall, Karwowski said, though she added many of Obviously’s pharma clients are in the “early days of influencer marketing” still.

“Pharma companies have sort of played small with influencers,” she said.

The biggest hurdle will be ensuring there’s compliance with various laws and regulations, she added. The FDA has an FAQ 

 on what an ad has to say, what qualifies as violating the law, and what’s required for a broadcast TV ad vs. an ad featured only online. (See Hims & Hers’s Super Bowl ad, which lawmakers and healthcare experts 

 earlier this year for allegedly being “misleading.”)

And while platforms like TikTok require any healthcare products to be FDA compliant, there’s also a growing movement of 

 who document their experiences using various GLP-1s. Which again gets to the “authenticity” of it all: Creators can answer viewers’ questions and track their progress along with any symptoms they may feel, all while followers watch and engage, Karwowski said.

“This is in a very public forum with someone jumping on a livestream and you’re chatting with them. So it does, I think, mark a big shift for pharma overall, and you really can’t ignore social media [for pharma marketing] anymore,” she said.

Serena Williams holding a GLP-1 sharp near the underside of her arm

Serena Williams as Ro’s celeb ambassador could mark ‘a big shift’ in pharma advertising

Pharma isn’t known for big-name celebrity appearances, but Ro’s approach could change the landscape.

Angel Foster only enters the US via Canada, where she’s a professor. She doesn’t drive a car outside Massachusetts. And she doesn’t visit Florida, South Carolina, or other states that ban or restrict abortion.

These are the precautions this MD takes as founder of the Massachusetts Abortion Access Project (the MAP). It’s a service that prescribes and ships abortion medication via telehealth under Massachusetts’s shield law, which protects those physically present in Massachusetts from out-of-state penalties for accessing or assisting with abortion care.

Legal challenges to providing abortions via shield law have popped up over the last few months, but Foster and others 

. Foster envisions a future with even more providers working similarly from other states that have comprehensive shield laws.

“We have been trying to identify folks in those states who are willing to provide [this care], and then work with them to build out a practice so that they don’t have to reinvent the wheel,” Foster said. “They can piggyback on a lot of the things that we’ve learned.”

Twenty-two other states and Washington, DC, currently have shield laws, according to the University of California, Los Angeles School of Law. Eight of those—California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington—

 protect telehealth abortion even if the recipient is located in a state where it’s illegal for them to get care.

The Supreme Court struck down constitutional protections for abortion 

. The MAP was founded in September 2023. It serves 2,000 to 2,500 patients a month, 95% of whom are from states with bans and restrictions, Foster said. In 2024, about 10,000 abortions in the US were provided under shield laws each month, according to the nonprofit research organization the Society of Family Planning’s #WeCount tracker.

Though not a prescriber herself, Foster still faces a risk of prosecution if she leaves the state of Massachusetts. The MAP’s five prescribers know the risks, too. “I think we all went into working in the shield law space with the expectation that there would be a lawsuit at some point,” Foster said.

Beyond Foster’s practice, telehealth abortions are growing rapidly, making up to 

 by the end of 2024, compared to 19% at the end of 2023 and 7% at the end of 2022, according to #WeCount.

 found that this form of treatment is just as safe and effective as in-person abortion.

No one has been jailed for providing a telehealth abortion to someone in a state where the procedure is banned.

Recently, however, 15 attorneys general from banned states signed a 

“These laws are blatant attempts to interfere with states’ ability to enforce criminal laws within their borders and disrupt our constitutional structure,” they wrote.

 against a New York doctor who allegedly prescribed pills to a minor in the state. So far, New York’s governor has held strong and refused to turn the doctor over for prosecution. This, and the MAP’s close working relationship with the Massachusetts government, gives Foster hope.

“We’re feeling very confident about the ability of the Massachusetts shield law to protect us,” she said.

White pills floating across between two phones with a checkmark on one screen. Credit: Anna Kim

Abortion shield law provider encourages others to follow her lead

Recent laws have challenged the practice, but that isn’t deterring providers.

 for the past four years, virtual care platform Current Health is reclaiming its independence.

In a June 24 blog post, company co-founder Christopher McGhee announced plans to return as CEO of the newly autonomous company, which was founded in 2014 and helps health systems move patient care into home settings. Best Buy purchased the company for $400 million in 2021, though neither party disclosed the financial details of the 

McGhee spoke with Healthcare Brew about his plans for Current Health as he takes the helm once again. He told us he wants to focus the company on treating acute and complex patient populations as opposed to long-term chronic condition management, as that’s where he believes it can “most move the needle on outcomes for the patient and cost.”

This interview has been lightly edited for length and clarity.

What changes can we expect from Current Health now that you’re an independent company again?

I’m really trying to take us back to our scrappy startup roots. I want us to innovate and build out our product with urgency and deliver the absolute best frontline experience to our clinical users and to our patients. I want to see rapid innovation in what we do, in building our product, and expanding our product.

How do we continue to build out our health monitoring services and clinical team and what that team does?

How do we use more AI and automation to allow these programs to cost-efficiently scale? The world is dramatically different today than the one it was when I sold the company in 2021. The AI technologies that are out have fundamentally changed the game for how some of these services can be done.

How do we orchestrate all of the technology and all of the services that are going on in the home?

Then the fourth one is the business model: How do we make sure that it’s aligned to the way our customer makes money?

You have partnerships with more than 40 health systems, including big names like Mount Sinai and Mass General Brigham. What’s your strategy when it comes to deciding which systems to partner with? 

We want to work with any organization that wants to deliver healthcare in a different way and wants to deliver more of that healthcare in a community or home setting. Some of the most innovative and forward-thinking healthcare organizations are really small, but they’re making dramatic changes to care in their local communities. That can have a pretty dramatic impact on local cost and outcome improvement. We certainly aren’t just looking to partner with the biggest.

In your post announcing your return as CEO, you mentioned you want to build Current into the “world’s largest healthcare organization.” What are your biggest challenges to meeting that goal?

Honestly, just the status quo. When we started Current Health, there wasn’t necessarily a ton of acute and complex care in the home. Hospital-at-home existed, but it didn’t really exist at any scale. Fast-forward nine years, and it’s a seismic shift in the way healthcare is delivered in this country. Now all of the sudden, people are culturally and psychologically ready to deliver more care in the home than they were five, 10 years ago.

But I think the biggest challenge still remains the cultural change around moving from a world that’s very centric around large brick-and-mortar facilities to one where healthcare is delivered in the community and the patient’s own home. How do we get more solid payment models like the waiver, which 

 to be done? It’s a temporary waiver that 

Headshot of Current Health CEO and co-founder Christopher McGhee