by Joseph Kvedar – Global Health Connector Ambassador

I’ve been a telehealth evangelist since 1994. Reflecting on its integration into care delivery in 2026 is remarkable. One simple view is that this care delivery model amounted to little more than a curiosity until 2020, when the pressures of the COVID pandemic changed our needs for care delivery overnight. This is only partially true. Other advances in the decade leading up to 2020 paved the way for this rapid adoption. We became comfortable with video-based communication in our private lives (FaceTime, etc.). A number of pioneers (e.g., Ro, HIMS, Teledoc) launched web-based businesses that enabled consumers willing to pay cash for convenience to access healthcare services over the internet. Not to mention all the infrastructure (broadband, mobile, etc.) that made this mainstream.

The primary driver of telehealth adoption among mainstream healthcare providers was government (and later private insurer) reimbursement. Thus, my first 2026 update focuses on that topic. Since March 2020, the U.S. government has paid frontline providers for telehealth visits, but the change has not been permanent. Every year or so, Congress has agreed to a short-term extension of these reimbursement flexibilities. This has made it difficult for health delivery systems to invest fully in telehealth capabilities, as they fear those investments would be wasted if reimbursement does not continue. In February 2026, Congress passed the Consolidated Appropriations Act, extending Medicare telehealth flexibilities for two years through December 31, 2027. That covers geographic and originating-site flexibility, as well as expanded practitioner eligibility for occupational therapists, physical therapists, speech-language pathologists, and audiologists. This two-year runway is meaningful, and with 7 years of reimbursement, most health systems are now making telehealth a standard component of care delivery.

In 2026, the U.S. government launched two innovative programs to support telehealth.

The first, Advancing Chronic Care with Effective, Scalable Solutions (ACCESS), was launched in July 2026 by the Centers for Medicare and Medicaid Innovation. ACCESS is a national, voluntary alternative payment model for Original (fee-for-service) Medicare. It’s built to close the gap between how Medicare pays for care and what technology can now do for chronic-condition management. Participants — physician groups and other Medicare Part B providers — become “ACCESS care organizations” and deliver integrated care (in person, virtual, asynchronous, or other tech-enabled modes) using telehealth software, wearables, and lifestyle/behavior-coaching apps. Payment is tied to measurable health outcomes rather than service volume, not just an add-on to the input-driven fee schedule. It covers four non-exclusive clinical tracks: early cardio-kidney-metabolic (eCKM), cardio-kidney-metabolic (CKM), musculoskeletal, and behavioral health. The conceptual framing is very exciting, but it is far too early to predict its success.

A companion program from the US Food and Drug Administration is called Technology-Enabled Meaningful Patient Outcomes (TEMPO). TEMPO is a voluntary pilot that allows the FDA to exercise enforcement discretion — enabling digital health devices (software, wearables, sensors, AI-enabled tools) to be used in real-world clinical settings before they would normally receive full premarket authorization or meet Investigational Device Exemption requirements, in exchange for manufacturers collecting real-world performance data. The FDA plans to select roughly 10 manufacturers per clinical area.

TEMPO’s four clinical focus areas are deliberately aligned with ACCESS’s clinical tracks. The design intent: a device maker receives FDA enforcement discretion through TEMPO, allowing the product to be deployed within an ACCESS care organization’s patient care to generate the real-world outcomes data FDA wants to see, while the ACCESS organization gets paid based on whether that tech-enabled care actually improves outcomes.

Some other notable trends:

• AI is moving from novelty to infrastructure. AI is becoming a core driver of telehealth efficiency, handling automated triage, symptom checking, and predictive analytics for chronic disease management.
• Hybrid care is the default model, not an alternative one.
• Remote patient monitoring (RPM) and wearables are increasingly folded into chronic disease management (diabetes, hypertension, cardiac care).
• Mental/behavioral telehealth continues to expand, though it comes with its own regulatory wrinkle: the in-person visit requirement for behavioral telehealth was delayed until January 30, 2026, and the new law extends that delay.
• Most platforms are integrating more directly with EHRs, partly to satisfy documentation and billing scrutiny.

Telehealth has come a long way since 1994, but it is just now reaching its stride. I look forward to providing more updates as this care delivery model continues to evolve.