1033: How Telehealth Is Expanding Access to Care and How North Dakota’s Academic Health Department Model is Growing Public Health Talent

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, November 26, 2025. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Today: how telehealth is expanding access to care.

ASHLEY CRAM: 

Telehealth is an additional avenue for patients to access health services through their computer or their electronic device. This is particularly helpful for patients who face barriers to care, such as transportation challenges, living in rural communities, or limited access to primary and specialty care providers.

SHEEHAN: 

We're joined by Ashley Cram, a senior analyst for population health at ASTHO. As we'll hear, telehealth services have really expanded over the last few years.

CRAM: 

There's various what we call 'telehealth modalities,' which are- include live videos. So, that could be a platform like Zoom that allows audiovisual communication. It could also be a phone call, so that's audio-only, which is that real-time telehealth encounter without video. And then there is also remote patient monitoring, which is when a patient uses a device, such as a wearable, to collect their own health data, such as blood pressure, glucose, or weight, and then that data gets transmitted to their provider. So, each of those modalities is important and has their unique use cases that can improve health outcomes.

SHEEHAN: 

Yeah, that's quite a range, and how, how can audio-only kind of compete with that? How is that, um, how is that effective?

CRAM: 

Yeah, so audio-only is particularly beneficial for patients that may live in a low broadband area that cannot sustain maybe that live video interaction, or if patients don't have access to a video-enabled device, then that phone call or that audio-only can allow the patient to still talk to their provider, still talk about what issue they're facing and what they maybe can do to address that

SHEEHAN: 

And does the kind of service or the kind of care that's available or that can be used, does that- does that vary state by state?

CRAM: 

It does, yes. So, states have passed policy, or they've also written it into their Medicaid programs, what services are eligible to be reimbursed, or which providers may be able to deliver a service via each modality or telehealth broadly. So, it's definitely an opportunity for states who are looking to expand access to telehealth to pass those policies and to look at what's authorized and what patients can do to access healthcare services via telehealth.

SHEEHAN: 

What can states do to sort of expand their telehealth options?

CRAM: 

Yeah, so, one thing that states can do is definitely policy, passing legislation. So, we have recently seen, notably, Hawaii and Minnesota have passed legislation that extends the coverage of audio-only behavioral health services. We've also seen legislation passed in Louisiana that authorizes remote patient monitoring for Medicaid patients with chronic conditions and other patients. So, passing legislation like that and passing policy is definitely a key component that, and a key kind of strategies, that states have to expand access to telehealth.

SHEEHAN: 

So, you've touched on- a little on what states could do. Is there anything at the federal level regarding expanding or increasing usage of telehealth?

CRAM: 

Absolutely. So, as you mentioned, state pol- can definitely pass policy. The federal government can also pass policy, both within agencies, and then they also could use legislation to expand access to telehealth. So, a lot of that covers kind of what services may be eligible to be delivered via telehealth, what requirements need to be maintained to ensure services are appropriate- appropriately delivered. One example at the agency level is the Center for Medicare and Medicaid Services each year passes the Medicare Physician Fee Schedule, and that often outlines telehealth codes for certain services, such as remote patient monitoring. At the kind of policy law level, a lot of those outline any geographic requirements for Medicare or telehealth services. So, there's definitely kind of a lot of opportunities for both states and at the federal level to create policy and infrastructure to expand telehealth.

SHEEHAN: 

It really seems like telehealth, especially since the pandemic, has been increasing, and it's been a lot more common, especially in terms of public health. Do you see that trend continuing?

CRAM: 

I do. I think there's a there's a lot of work to demonstrate the value of telehealth, and that the instances where it is clinically appropriate and can expand access in a way that is meaningful for the patient's health outcomes. I think the benefits of telehealth has seen, especially during the pandemic, people really appreciated being able to talk to their provider or engage in health services that way. So, I think maintaining it as that kind of added opportunity to talk to your provider, it's not meant to replace the in-person services. However, using it to kind of augment the rest of care and being able to have those opportunities that aren't restricted by health professional shortage areas or transportation barriers. I think having those, I think it should continue, and likely will be continued to be prioritized as an opportunity to expand access to care.

SHEEHAN: 

Ashley Cram is a senior analyst for population health at ASTHO.

Now, let's switch gears and hear how an internship program in North Dakota is helping train a new generation of public health practitioners and creating leaders and mentors in the process.

TRACY MILLER: 

During COVID, we started working with our public health school to help us do some quick research, to help us do some basic data analysis that get information out the door.

SHEEHAN: 

Our guest is Tracy Miller, a state epidemiologist for the health statistics and performance section of North Dakota's Department of Health and Human Services.

MILLER: 

This was really accomplished by a few of us, working with Dr. Pamela Jo Johnson, who is the head of our public health division at North Dakota State University, and we worked with her to determine what are the number of hours students could spend working with our division, what the cost would be, and how does it benefit, not just the health department, but also our our students that we were going to be working with.

SHEEHAN: 

And what kind of lessons were learned in that process? What, what were the benefits from doing it that way?

MILLER: 

The very first year, we had about two students that started with us, and, you know, we used this opportunity to really focus on, where do we need to improve? What could be done better for the students, what could be done better for the health department? What can be done better for the school? We focused on second-year grad students that very first year, and we utilized kind of our senior epi personnel to actually start the program. It was myself and two of the unit directors in my- in this section that were kind of the mentors. And while it worked, we felt like it could have been done better. And so, the second year that we got it, we focused on getting first-year grad students versus second-year, and we turned it into a leadership learning opportunity for other epis in our section. Instead of having our senior epidemiologists be the mentors and the supervisors, we moved to our program personnel, and they had a little more time to dedicate to the student interaction, and they were able to learn, like leadership responsibilities and supervising, and so, it became a tool for them as well. This change really made a huge difference in our success.

SHEEHAN: 

That's great. Does it seem like the model you've created could be replicated elsewhere, and if so, what- what lessons would you try to suggest?

MILLER: 

It's a lot of work. In the beginning, you are going to have to find people who have the time to truly mentor, but not to get discouraged. Even though it takes a little while to get them up and running and to get the whole program going, there's always going to be some trial and error, and so, you need to kind of find that fit that works the best in your area of the health department. My advice would also be to also look at it as a learning opportunity for some of your- your own newer staff, instead of putting it on senior staff who are already busy. And so, looking at your mid-levels and your newer staff, they have- may have a little bit more time to devote, and would welcome that opportunity to learn new leadership skills and supervising skills. And so, it becomes a win for both sides of the coin on that. And I think in order to get the most out of- out of the students, really consider giving opportunities to those that are new to public health. You might have them for longer terms, or they develop skills and become a little bit more experienced in your department, which will allow you to give them more responsibilities as they go through the program.

SHEEHAN: 

Tracy Miller is a state epidemiologist for the health statistics and performance section of North Dakota's Department of Health and Human Services.

For states exploring opportunities to expand telehealth, ASTHO has published an online resource that can help states identify opportunities to leverage funding policy and establish infrastructure that expands access to telehealth services. This assessment is available in the show notes, and the ASTHO team is available to support states think through any questions or guidance that would be helpful.

ASTHO is seeking proposals from qualified organizations to design and implement a rapid response opioid and pain management ECHO aimed at strengthening provider capacity to manage patients affected by prescription-controlled substance disruptions. Learn how your organization can lead this critical initiative by heading to the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.