Speaking to health care leaders, providers, and medical students at Jump Trading Simulation & Education Center in Peoria, Illinois, Kyle Zebley, senior vice president of public policy for the American Telemedicine Association (ATA) and executive director of ATA Action, said the lapse wasn’t caused by technology or lack of provider readiness but by government dysfunction.

“On October 1st, patients across the country woke up to discover they had lost access to their doctors overnight,” Zebley said. “Not because of a technological failure or malpractice, but because of politics. That morning of October 1^st, Medicare telehealth flexibilities, the lifeline that millions of Americans had come to rely on, simply expired.”

The lapse affected Medicare fee-for-service beneficiaries and hospitals, including OSF HealthCare Saint Francis Medical Center in Peoria, participating in the federal Acute Hospital Care at Home program, after Congress failed to extend pandemic-era telehealth flexibilities. Although most private and Medicaid plans continued covering virtual visits, the sudden loss of federal authorization created confusion for providers and patients alike.

During the OSF OnCall Digital Health Symposium keynote speech, Zebley called the situation “a product of dysfunction, delay, and short-term thinking,” despite years of bipartisan support for telehealth across both the Trump and Biden administrations.

He stressed telehealth became collateral damage in a larger breakdown of governance.

On the 41st day of a record-long government shutdown, the U.S. Senate voted 60 to 40 to approve a continuing resolution to reopen the government. The measure would fund much of the government through January 30 and provide funding for some agencies through the end of next September. It also includes an extension of a waiver that allows for telehealth services for Medicare recipients.

Need a permanent fix

Zebley has been urging lawmakers to transform temporary extensions into permanent, digital-native health policy that provides stability for hospitals, clinicians, and patients. He argued that bipartisan goodwill alone is not enough. But Zebley is not convinced the rollercoaster ride is over.

“In the short term, it’s going to continue to threaten at least to be the rollercoaster that it has been in 2025. We have two political parties at total loggerheads – putting aside their agreement on the efficacy of telehealth and virtual care services – they disagree about almost everything it would seem.”

Zebley pointed out OSF HealthCare has been a leader in using digital technology and virtual care to transform health care.

“OSF has continued, through OnCall (its digital health arm), to really push the boundaries of their workforce and push the boundaries of increasing their capacity to do more good for more patients wherever those patients might be. He added, “They really are the gold standard in the use and deployment of technology.”

However, he argued health systems such as OSF can’t build business models around continuing resolutions. Clinicians can’t plan care around congressional calendars. Patients shouldn’t have to wonder whether their next therapy session or prescription refill depends on the latest vote count in Washington.

The future of telehealth

His vision for the future – a “digital-native, AI-enabled” health care system, where policy keeps pace with innovation and where care is continuous, data-driven, and equitable. The telehealth leader emphasized technology has advanced rapidly – from remote monitoring and hospital-at-home programs to AI-assisted diagnostics, but policy and regulation have lagged behind. Zebley stressed a permanent fix is needed.

“So that our fellow citizens, yourselves included, can lead healthier, better lives with more individualized care treatment that really is able to take advantage of the massive reams of data that our health care system can and does produce and come up with bespoke health care plans for them that meets them where they are.”

The lack of a permanent policy, he argued, doesn’t just slow innovation, it denies care.

The ATA and ATA Action are coordinating national coalitions to push for long-term reform, including the ATA Action Advocacy Council, the Virtual Foodcare Coalition, and the Advancing Digital Health Coalition, all aimed at ensuring that digital health access remains stable and bipartisan.

The ATA, through its Center of Digital Excellence is also continuing to collect data to provide additional evidence that telehealth is safe and that it is expanding access to care despite a shrinking workforce.

Regardless of the current lapse, Zebley is optimistic Congress will eventually make telehealth coverage permanent because he says it is one of the rare success stories of American health policy. He reminded those in the room in Peoria that data has already shown that telehealth is not only popular, but it is efficient, cost-effective and patient-centered.

Kyle Zebley

B-roll-OSF OnCall Digital Health Symposium

The $17.8 million project will add 25 new intensive care unit (ICU) rooms, more than doubling the hospital’s ICU capacity from 14 to 29 beds.

The modernized space features a centralized and expanded care team hub, designed for efficient patient monitoring and quick access to patient rooms. Attention to detail was a priority in both function and aesthetics.

Pointcore Construction Program Manager Jordan Sondag notes that ergonomic design and nurse and provider input guided placement of bedside utilities like oxygen and IV hookups, as well as nurse documentation stations with dimmer switches for lights and room-facing windows for better patient visibility.

“The finish selections and paint colors are soothing and healing,” said Sondag. “This space reflects our commitment to compassionate, high-quality care – and we want patients to feel that from the moment they walk in.”

The expansion repurposes the former Center for Healthy Lifestyles and incorporates space from an adjacent courtyard. The relocation of the ICU will allow OSF HealthCare in the future to construct a new patient tower which will add 60-65 additional private beds.

Sondag also said one of the biggest challenges was adapting the design to the hospital’s existing structural grid, which required extensive excavation and reinforcement to support the new infrastructure and equipment.

Eunmee (UHN-mee) Shim, OSF HealthCare St. Joseph Medical Center president, says the transformation is part of a larger strategy to allow OSF St. Joseph Medical Center to be a regional referral center. Over the last few years, the hospital has been forced to deny hundreds of incoming patient transfers from smaller community hospitals due to being at capacity, making the expansion project key in serving surrounding rural communities.

“They’re losing a lot of services, so as a regional referral center, we will be receiving a lot more patients; many of them can’t get the care they need in their own community therefore likely they will be delaying care and presenting themselves much sicker.” 

McLean County’s population is growing rapidly, driven in part by expanding local industries such as the Rivian auto plant and the recent opening of Ferrero’s candy factory in Bloomington – both of which are increasing demand for health care services. Additionally, Shim points out OSF St. Joseph will be offering a more comprehensive range of care and is expanding its number of providers to meet the evolving needs for convenient specialty care.

“We will be adding complexity of patients because we’re adding more complex services and bringing additional providers with specialties that we have not had before and all of that will require us to have bigger and better prepared critical care beds.”

OSF St. Joseph currently offers a wide range of services such as cancer care, pregnancy and birthing, emergency services, heart and vascular care, neurosurgery, and more.

Hayley Aeschleman, manager of ICU, step-down and centralized telemetry, says the location of the new ICU is better for patient privacy and safety.

“We are right across the hall from the operating room, which is really exciting, especially when you have patients who might need emergent surgery. Sometimes you’re just really prepping them for surgery and then sometimes actually running that patient to the OR from ICU to make sure we can give them care they need to save their life. So, now instead of going across the hospital, we’ll be just literally right across the hall, which is super exciting.” 

Courtney Bier (BEER), director of inpatient nursing services, said nurses and managers provided important input about room layout and features needed to meet the demands of caring for sicker patients with more complex health challenges. For example, when the project started, there was not a lift in every patient room.

“Throughout the design process, getting feedback from other leaders; from critical Mission Partners (employees), we realized how important it was to have those lifts both for the patient safety as well as for the Mission Partners’ safety because again, our patients are sicker. They’re able to do a lot less for themselves and we need to keep our Mission Partners safe while also making sure we’re meeting our patients’ needs.” 

Telehealth technology is being integrated into the new ICU rooms to accommodate tele intensivists and additional monitoring from OSF OnCall, the digital health arm of OSF HealthCare with a centralized command center in Peoria, Illinois. Bier says each ICU room is equipped with a monitor and camera. As former night shift nurses, both Bier and Aeschleman say the extra support is comforting.

“We find OSF OnCall so valuable, especially in the ICU – sometimes it’s just another set of eyes like, ‘Hey, I need a second opinion – there’s not another person available on the unit’ – and so I’m very excited we have that capability.” 

Shim says the expansion is requiring nearly doubling the number of providers and support staff, such as patient care techs and certified nursing assistants. It has resulted in hiring many new graduate nurses and a total of 100 new full-time Mission Partners. The changes also put OSF St. Joseph Medical Center on track to transition the hospital to all private patient rooms.

Jordan Sondag and Eunmee Shim

Hayley Aeschleman and Courtney Bier

B-roll for 25 bed ICU expansion, OSF HealthCare St. Joseph Medical Center

Digital health technologies have allowed people to access care where and when they want it because of computing platforms, software, sensors, and connectivity.  But, Sarasohn-Kahn says connectivity is a barrier for some who are experiencing gaps in care. 

“Because not everyone has connectivity. It costs money that a lot of people don’t have to spend. So, this is a limiting factor that we can address but we shouldn’t be pollyannish about this for everybody because not everybody can get online, and we learned that during the pandemic.” 

Connectivity, says Sarasohn-Kahn, is a social driver of health, much like transportation, food, housing and other social needs. She emphasized that partnerships with community and government organizations will be needed to create what she called “techquity”— tech equity. 

Universal access to innovations can help reduce inequities and remove barriers to care for underserved populations. Sarasohn-Kahn points out innovative health systems such as OSF HealthCare are investing in new technologies, providers, and data scientists to drive better health and prevent hospital admissions. Now, evidence is starting to show returns on that investment in better patient care and reduced treatment costs. 

Globally, she says for every $1 invested in telehealth, there is a $19 return to the economy in increased productivity and reduced health care costs. But trust is a major factor in driving consumer engagement in telehealth.

Sarasohn-Kahn says misinformation that began during the pandemic and that continues today is driving down trust in health care. 

 “Without trust, people will not engage with you as a health care provider. There has to be that sacred, and I use the word sacred because it’s real, it’s (a) deep bond of trust and it’s a precursor to health engagement.”

Technology is allowing the movement of more care to the home. Blood tests, labs, and imaging can increasingly be performed in the home or remotely. Sarasohn-Kahn says the growth of digital health apps, digital therapeutics and increased use of sensors integrated with smartphones that can passively monitor patient metrics is advancing convenient care. Plus, there's been increasing expansion of videoconferencing for virtual visits from anywhere. 

She emphasized that health systems can take a lesson from OSF and embrace collaboration to boost trust, access and equity. For example, trusted community organizations can be partners to help build one-on-one relationships with people who don’t trust health care. Once patients engage and have a great experience with a virtual visit or using a platform for health monitoring or other technology, Sarasohn-Kahn suggests they will help others get on board.

“Once you start that process, people will engage, ask more questions and then they become your evangelists in the community. She shared, “I’ve seen this over and over. It takes a lot to get (trust) up, but once you get that relationship going, it can be a beautiful thing.”

Faster computing power and use of generative AI will also transform health care.

Artificial intelligence will be embedded in so many aspects of our lives, including health care. And, with proper governance and ethical use, Sarasohn-Kahn says it can make the most of a shrinking and increasingly burned-out workforce. She outlined several practical applications.

“In research trials, marketing personalization; same way it will have in health care decision making, productivity – not to replace jobs but to enhance people’s ability to do more and have the lower, easy low-hanging-fruit stuff done so that you can concentrate and work at the top of your license whoever you are and not just for clinicians but for all workers to work at the good stuff.”

From her research and personal experience Sarasohn-Kahn says its clear health consumers have mixed feelings about AI and data privacy. But, she says many are willing to share their data if they see the value in doing so. For consumers, she advises making sure to use apps that are HIPPA compliant (legislation that protects personal health information).

Finally, what is also needed to drive more engagement with telehealth? Sarasohn-Kahn says a federal data privacy law that mirrors what is in place in Europe, based on the premise that all consumers should have complete control over their own personal data.

Video clips with Jane Sarasohn-Kahn

B-roll for digital health symposium

Your toddler spent the day in the pool and now has a weird rash that’s kept her up all night. You’re feeling a familiar pain, and you just know it’s a urinary tract infection but you’re leaving for vacation in the morning.

These are typical summertime scenarios, and instead of having to wait until a walk-in clinic opens, OSF OnCall Urgent Care offers virtual care options that are available 24/7 year-round, including holidays and weekends. 

Kate Barth, vice president/chief nursing officer for On-Demand Services, OSF OnCall, says consumers want health care options that are convenient, like what they’re used to experiencing with online shopping and banking, so OSF offers lower-cost, easy virtual urgent care options, especially when a minor illness or injury happens after hours.

“It’s the mom with multiple children who are sleeping and (she thinks) ‘I have a sick kiddo who I cannot console and what do I do?’ Seeking out virtual urgent care in those options is such a great opportunity to connect with a provider who typically would serve you in that urgent care setting.”

 AAA projects Independence Day travelers will set new records both nationwide and in Illinois. More than 70.9 million people around the U.S. are expected to travel 50 miles or more away from home with 4.1 million being Illinoisans. Barth says if you’re away from home, no problem.

If there’s Wi-Fi, internet or a hotspot near a campsite or at a hotel, a video visit with an OSF OnCall provider could be more convenient than finding the nearest walk-in clinic.

Individuals who want to virtually access OSF OnCall Urgent Care can select an online interview (taking between 5-15 minutes) where they’re asked a series of questions about symptoms and how they’re feeling. Their information will be reviewed within an hour. Using a chat feature, additional information could be requested before an OSF HealthCare provider offers a treatment plan. 

“Maybe the provider would need to visualize the bug bite or something that looks like a rash, so we do have that video option also available to be able to assess that situation and be able to give a diagnosis in that case as well.”

If treatment requires medication, a prescription can be sent to the pharmacy of the individual’s choice.

What happens if the online consult or video visit reveals someone needs to be seen in-person?

“We all know there are things that sometimes can’t be virtually treated. Sometimes a lab test may be needed, or a hands-on assessment might be needed to confirm a diagnosis. In that case, we simply refund that virtual visit knowing that it is best-case scenario for you to be seen in an actual urgent care setting.”

For example, sprains and strains can usually be assessed virtually, but broken bones can only be confirmed through an X-ray, which is available at an OSF OnCall Urgent Care walk-in location.

Barth points out, those walk-in clinics also offer more than simple urgent care.

“Employee physicals or drug testing as well as those school and sports physicals that we always catch ourselves running behind on where at the last minute a child says, ‘I need this for tomorrow!’”

The cost of virtual care is less than an in-person visit. An online interview is $30 and a video visit, typically lasting between 15 to 25 minutes, is $60. OSF OnCall Urgent Care accepts a wide variety of insurance plans. Medicare patients are welcome to use an OSF OnCall Urgent Care option, however a virtual visit is not currently reimbursed.

Anyone experiencing a medical emergency or symptoms such as chest pain, breathing difficulty or severe abdominal pain should go directly to the nearest emergency department or call 9-1-1.

Video Clips of Kate Barth

B-roll of Virtual Urgent Care

More than 1.5 million rural Illinois residents face significant health care access barriers due to a lack of resources and limited infrastructure. OSF HealthCare serves many rural communities in Illinois and Michigan and leaders are looking at telehealth and digital health tools and platforms to bridge those gaps.

Part of the strategy involves collaborating with academic partners such as Illinois State University in Normal. A team made up of faculty at ISU and clinicians from OSF is working on a project to educate the future workforce on using a telehealth platform that can allow real-time assessments, consultations, diagnosis and creation of care plans, along with providing health education for people with chronic conditions in rural, medically underserved communities with aging populations.

The project called STARTED – Simulation to Address Rural Telehealth Education Development is funded by a joint OSF-ISU Connected Communities grant as part of an ongoing collaboration.

Associate Dean for Academics, Susie Watkins, PhD, RN, Mennonite College of Nursing at Illinois State says the platform will allow nurses to hold pop up clinics in homeless shelters or other community sites.

“This would help us provide some care in a community like that where they don't otherwise have access to health care, and that could potentially avoid them having to use the emergency room for things like ear infections and strep throat,” Watkins says. 

The platform also has attachments that can be used for physical exams performed by a nurse. Data and video from the exam could then be sent back to a provider at a distant hospital or clinic to review and offer a diagnosis and treatment recommendations, including prescriptions or referrals to a specialist.

Watkins holds up attachments as she explains, “It has an attachable otoscope that would record a full ear exam to determine if the ears are inflamed, and then also has an oral tongue depressor feature that one could examine the back of the throat for potential tonsillitis. 

There are other devices that can connect to the platform to provide assessments on heartbeat, lung sounds, blood pressure and other tests such as blood glucose levels that can be sent to the off-site provider via the platform.

The Director of Interprofessional Education at Jump Simulation, Ann Willemsen-Dunlap, CRNA, PhD, is co-lead on the collaboration for the first year of training 120 Bachelor of Science in Nursing (BSN) and 24 Family Nurse Practitioner (FNP) graduate students. She’s supporting the development of web-based learning modules that use patient scenarios, video vignettes and telehealth simulations using standardized participants.

Trained actors will be used

Standardized participants are specially trained actors who portray patients from rural communities with various health challenges. The actors also provide an assessment with standardized metrics that measure competency in various areas including wellness screening, disease specific illness-related triage, disease self-management support using motivational interviewing and person-centered goal planning techniques. Willemsen-Dunlap says the standardized participants also give verbal feedback once the simulation is over.

“They’re going to be talking with their learners about how the interaction made them, as patients, feel from a first-person perspective.” 

Willemsen-Dunlap says eventually community health workers, as trusted advisors, can be trained to go into homes within medically underserved communities to help patients get comfortable with the portable technology that allow for in-home exams, rather than requiring patients to travel long distances for care.

“I think that having a community health worker present in the home to facilitate the interaction and nurses who are skilled and comfortable working in the digital environment, as well as providers who had similar training is going to be the key to success,” Willemsen-Dunlap stresses. 

Other funding sources are being sought from governmental or non-governmental organizations to support additional work to implement a rural health mobile clinic that uses this training and technology to deliver exams and health-related care within underserved communities.

In areas of so-called connectivity deserts, where the internet is not available or is unreliable, OSF OnCall, the health system’s digital care arm, could use an OSF OnCall Connect On the Go van for exams using the enhanced virtual platform and on-site connectivity.

Watkins says one-third of older adults in rural communities have two or more chronic diseases so its important patients continue to stay on track in managing them.  

“This technology would allow nurses to connect with patients on an ongoing basis between provider visits and do that condition specific assessment and also the self-care assessment and make sure that the patient is staying on target with their goals and all of the treatment recommendations made by their provider at the previous visit.” 

In the future, training could also involve behavioral health or dietary students who could be brought in on a telehealth visit to receive training on how to address additional concerns that are influencing a patient’s overall health and wellbeing.

Video clips with Susie Watkins

Video clips with Ann Willemsen-Dunlap

B-roll of robust telehealth platform

You visit a health care provider for a minor ailment, and you leave with a plan to get better. It could be medication or changing habits, combined with follow-up appointments.

But the issues in the background don’t go away. You might say to yourself:

•  I don’t have a car or childcare. How am I going to get back for the important follow-up?
   
•  A gas station is the only place around me to get food. I can’t go for walks because it’s unsafe. How am I going to start living healthier?
   
•  I can’t afford a new mattress. What will stop my back from hurting in the morning?

These outside, non-medical factors are called social determinants of health. Health care providers everywhere are trained to ask people about them and link them with resources.

Lucas Edwards, PA, is a primary care provider at OSF HealthCare in Godfrey, Illinois. He sees social determinants of health come into play frequently.

“[Some] patients don’t have a car or someone they can depend on for consistent rides,” Edwards says. “They might have something that’s going on that’s medically urgent, and they can’t get to where they need to go. And so they put things off until it gets to the point where things get a little bit out of control.”

In those cases, people usually end up in the emergency department – nobody’s idea of a pleasant day and a more costly way to receive care.

To keep social determinants of health in mind, Edwards says to speak up when you make first contact with your provider’s office – whether that’s on the phone, checking in on a tablet at the front desk or with a medical assistant in an exam room. Tell the person about your circumstances and be willing to answer when asked about the same.

The provider will see you for what brought you there, of course. But they might also direct you to programs within the health system or in the community to help. For example:

•  An upcoming visit may be changed to virtual, an option that became more common during the pandemic.
   
•  You might be able to get care at a reduced cost.
   
•  You could be referred to a social worker.

Edwards also says a simple conversation may enlighten.

“Some patients may not have had the same access to education. They don’t understand that they have this wound on their leg, and if they don’t keep it clean, it can get worse,” Edwards says.

“The provider and the patient need to be on the same wavelength. They need to understand why I want them to do something,” Edwards adds.

There’s one last player in the social determinants of health world: the people responsible for a community’s infrastructure and other daily things we often take for granted.

For example, your doctor can treat an infection. But if you go home and drink the same contaminated water, you’re back to square one.

Or, things cost more at the grocery store than they used to.

“We work with patients who have financial constraints. They have a fixed income, and they can only spend X amount on some object,” Edwards explains. “You need to go to the grocery store and get your bare necessities. So a lot of times, their health care dollars they have budgeted get dwindled.”

“It takes a village,” to keep everyone healthy, Edwards adds.

OSF HealthCare is proactive on social determinants of health. An ongoing effort aims to have people coming to medical offices fill out a social determinants of health screen at least once a year, either through their online patient portal or on a tablet at the office. Among patients screened so far, around two-thirds identified a social need.

Learn more about social determinants of health on the World Health Organization website.

Interview clips

Previous coverage

OSF Newsroom stories on social determinants of health

OSF HealthCare blog: Caring for patients beyond the health care setting

Tackling any task – from a child walking to an adult learning a new job – starts with a first step. The same goes for taking care of your mental and behavioral health, but even the experts admit it may be daunting to ask for help. During the holiday season where some people may experience loneliness and depression, experts are reminding you there are resources to bridge the gap between “what do I do?” and “I have the care I need.”

Katie Koeller is a behavioral health navigator (BHN) at OSF HealthCare in Alton, Illinois. BHN is a free, ministry-wide service at OSF HealthCare, but you don’t have to be an OSF HealthCare patient to use it. The program helps people in areas like depression, anxiety, drug or alcohol use, and problems with work, school, or relationships. The BHN talks to the patient – either at a provider’s office or over the phone – about what care they need, and they point the person to that care as close to home and as soon as possible. The BHN also checks the patient’s insurance coverage to see how it lines up with the care needed.

“We would do an intake,” Koeller explains. “So we'd ask questions, making sure that they're not in a crisis situation at the time and see what their symptoms are. And then that way we can better judge what they would be suited for as far as counseling, psychiatry, substance use treatment, whatever it may be.”

Koeller notes the treatment could be out-patient (the typical office visit) or in-patient (live-in treatment). She says a BHN will also check-in with the patient via phone call or message on OSF HealthCare’s secure online portal. Koeller says it’s usually three check-ins over a month, but each case is different.

“Some people just decide maybe it's not what they need, maybe just talking with somebody like me and just getting educated and feeling like they have that opportunity or just the knowledge about the community resources is enough,” Koeller says. “Because then they were like, ‘Well I can decide later on if that's what I need.’  But for the most part, I feel like a lot of patients are appreciative and do really like the service and find it helpful.”

Koeller, a BHN for three years, says even if the patient is on a good path, the BHN tells them they can always call back if they need more help.

The tendency to stay quiet about mental health is still an issue, Koeller says. But she’s seeing another roadblock to care.

“A lot of people just feel like they don't have time for it. I've heard a lot of people say that ‘I can't take off work for it.’” Koeller says. “I feel like a lot of people don't consider it to be [a crisis]. You don't want it to get to that [crisis] point. So they kind of push it back like it's not as important as my physical health.”

But in reality, Koeller says, mental health does impact physical health. In other words, if your mind hurts, your body may hurt, too.

Koeller also notes that some insurance providers can help with transportation – getting a ride to a counselor appointment, for example. Telehealth – a digital appointment with a provider from home – is also an option that’s growing in use. OSF SilverCloud is another resource designed for workplaces. These are some of the many things a BHN can check on and, at a minimum, educate the patient on what’s available.

Patients who are experiencing a mental or behavioral health issue can contact their primary care provider or – if you live within OSF HeathCare’s footprint – use the behavioral health navigator program. If you’re in a crisis situation that needs a first responder, call 9-1-1. If it leans toward a mental health crisis, call the National Suicide Prevention Lifeline at 9-8-8.

Interview Clips