Podcast - Inside Telehealth's Growth, Regulation and Access

Morgan Ribeiro: Welcome to Counsel That Cares. This is Morgan Ribeiro, the host of the podcast and a director in Holland & Knight's Healthcare Practice. Today, we are looking at the intersection of the high-growth area of telehealth and the rigorous regulatory frameworks that keep it safe. We will discuss the high-level business considerations that are unique to creating and developing telehealth platforms, and we'll identify the complex decisions that are unique to developing these platforms and much more. I am thrilled to be joined by two experts in this space. First, we have Shalyn Watkins, who is a senior counsel in our Newport Beach office, who has a deep background and deep experience in healthcare regulatory compliance and HIPAA advisory, and our special guest, Amber Gill, who is the CEO of Receptive. Amber will share more background on her company here in just a minute, but she leads a modern telehealth platform that provides accessible evidence-based care across all 50 states and specializing in areas like mental health assessment, ADHD treatment and nutrition counseling. So, with that, Amber and Shalyn, thank you for joining me today.

Shalyn Watkins: Thanks for having us.

Amber Gill: Thanks for talking to us.

Morgan Ribeiro: Amber, I would love to start with you. Can you tell us more about your company?

Amber Gill: Absolutely. Receptive is a telehealth platform focused on making care more accessible, affordable and personalized. We operate across all 50 states through three brands that address different but highly connected needs: mental health and disability accommodation support through ADHD assessment and ongoing treatment through ADHD advisor and nutrition counseling through top nutrition coaching. At the core, we're focused on reducing barriers to specialized care. We build systems that make it easier for people to access qualified providers, receive high-quality support and continue care over time in a way that feels simple and empathetic.

Morgan Ribeiro: Awesome, well, I look forward to diving a little bit deeper into all that you all are building there. Shalyn, do you want to share more about your practice and the work that you do with telehealth clients?

Shalyn Watkins: Yeah, at Holland & Knight, we represent a myriad of different healthcare providers. I tend to love my work with telemedicine and telehealth providers specifically. We work with these types of providers and related companies from soup to nuts. So, I love working with companies like Receptive, where Amber is in startup mode. And then we keep them compliant and get them to the place where they can be really profitable ventures for future acquisitions or feature IPOs. It's really fun work, and we love to watch our clients grow and continue on.

Morgan Ribeiro: Awesome. Well, thank you both. Amber, you have spoken a bit about breaking barriers in healthcare, and when building the Receptive platform, I'm curious, what were some of those kinds of primary frictions that you saw in the traditional healthcare system that you felt that telehealth could solve for?

Amber Gill: One of the biggest things we saw was that the healthcare system often creates friction at the exact moment someone is trying to get help. That friction looks different depending on the type of care, but the result is often the same. People delayed care or never started at all. For many individuals, especially those with ADHD, the system itself is the obstacle. Finding the right provider, understanding where to go, navigating long wait times, dealing with stigma and managing all the administrative complexity can feel overwhelming. And for someone already struggling with executive dysfunction or executive function, that process can be enough to stop care even before it begins. We believed telehealth could solve that by making care more immediate, more understandable and just more human. Our goal was to build something that meets people where they are, remove unnecessary complexity and still maintain a high clinical standard. That combination of accessibility and quality is what we think matters the most.

Shalyn Watkins: And Amber, I think one of the fun parts about telehealth and telemedicine is, while it's been existing for a little bit, COVID-19 really taught us how necessary it was to get care to individuals because everyone couldn't necessarily leave home. And so, we realized that care was not just for respiratory illness. There were a lot of other things that individuals were being impacted by in the COVID-19 pandemic, which opened up the landscape for companies like yours to really fill that void.

Morgan Ribeiro: Part of what we'll talk about today is just like the regulatory environment, right? Created a place where it was more flexible. And so how do we kind of continue some of those things? You know, and regulations that were implemented at that time, right, to allow us to kind of expand into some of these areas like what Receptive is offering.

Amber Gill: Telehealth is just becoming more common ground now after COVID, and people are starting to use it as preventative care and ongoing care instead of just a secondary option.

Morgan Ribeiro: Amber, can you talk about your staffing model and how you bring on board-licensed providers?

Amber Gill: Yeah, we hire independent contractors for all of the business that we support, and so we have open advertisement for talent acquisition, and we match it based off of the demand we're seeing so that we can bring providers. And if demand's increasing in the state of California, we can look and see we need more nurse practitioners with TA licenses. Or maybe in New York we need a registered dietitian. And so, we just open up postings essentially to match the demand based off the credentials we need. We sign independent contractors with the providers and then help with the administrative flow for onboarding, credentialing and setting up with all of the e-script integrations if needed.

Morgan Ribeiro: So, can you explain how a telehealth platform like yours relies on the providers to guide clinical decision-making and how virtual healthcare relationships rely on various components to achieve that ultimate goal of making care accessible?

Amber Gill: Absolutely. A company like ours is not practicing medicine or making clinical decisions. Our role is to build the infrastructure that helps connect the individuals with the qualified licensed providers and then supports those providers in delivering the care effectively. That means we focus on the operational side of access: building the platform, coordinating logistics, supporting scheduling and creating a patient experience that feels seamless. But the actual clinical relationship is between the patient and the provider. The provider is the one who evaluates the individual or determines whether a diagnosis is appropriate and decides what treatment plan makes sense and then uses their professional judgment throughout the course of care. In our ADHD business, for example, we provide administrative support to physician groups that oversee care delivery. In our other businesses, we work with independent providers and provide our own entities that are responsible for the clinical services they offer. That distinction is incredibly important. And at the same time, access only works if the non-clinical pieces are working well, too. You need the right provider network, strong onboarding, compliance systems, reliable scheduling, responsive support and a care model that encourages continuity. And then when all of those components come together, virtual care can meaningfully expand access without compromising the quality.

Shalyn Watkins: So, you're kind of like a matchmaking service for patients to find their ideal clinician in their time of need. And I think that's kind of cool, right?

Amber Gill: Yeah, I like that. Healthcare feels very fragmented, and so we're just trying to pull it all together and make it as simple as possible for everyone to utilize.

Morgan Ribeiro: Well, and especially I think people really struggle with finding providers where they can get in and the waitlists can be long and how payment works and everything else. So, making this virtual, I think it just eliminates some of those barriers that you had mentioned. I'm curious, how do patients find you all?

Amber Gill: They find us, a lot of them search on Google or other search engines. They look for ADHD care with me, or they're searching, you know, my landlord won't accept my pet. How can I find help? And so, we have different blog articles, content, different ads that can help inform users. And then it just directs them to our website, where we can match accordingly.

Morgan Ribeiro: OK, so Shalyn, turning to you as the attorney who is advising telehealth and, I'd say even more broadly, digital health companies, what are the biggest regulatory tripwires you see for companies like Receptive that are scaling rapidly across a number of state lines?

Shalyn Watkins: Yeah, I think one of the hardest things about working in a digital field is that the regulations and the laws are not moving as fast as technology is moving. And so, a lot of what we do is play catchup, but also reacting to rapid changes on the legal side of things. One of the biggest tripwires we see for clients, especially if they're, you know, working in certain professional services like providing physician care, is the corporate practice of medicine rules. They differ in all 50 states, and a lot of these platforms, just like Amber's, operate in 50 states. So, they have to be able to individualize their models to react to each of those states' corporate practice of medicine laws, but also make it so that they're not having 50 different types of operations running at any given time. And so we work really closely with our providers. We identify the fact that what works here in California may not fly in Texas and how can we marry those two concepts and make it work for both the ultimate end user being the patient but also for the business model that our clients or the providers are engaged in.

We also see a lot of movement in health information privacy since everything is digital. There's a lot more data at stake. You know, nobody talks to their provider and their provider isn't just writing some notes on a piece of paper anymore. There's a lot of exchange electronically of health information, which is usually encapsulated by not only HIPAA but individual state data privacy laws, which in the last few years have become expansively different and are continuing to grow. And once we have a telehealth company that's set up from that kind of baseline structural requirement, we have to start thinking about policy and procedures, how to keep it operationally consistent, how do we react when, you know, a state drops a brand-new data privacy law or, for example, you know, if we see traction like at the end of last year, we saw a whole new scheme in Oregon for the corporate practice of medicine. How are we going to start evaluating and reacting? And we have to just stay above the curve at all times, which makes this really a fun part of my practice.

Morgan Ribeiro: It's certainly never a dull moment, I think, you know, from the regulations and just it's not, you know, necessarily specific just to telehealth. But I mean, even the AI laws that are changing that impact telehealth or, like you mentioned, the data privacy and security regulations, all of that kind of impacts this larger sector. Amber, going back to you, I'm curious, from your role as a CEO of a telehealth company, how the legal realities are impacting your day-to-day. Does the heavy lift of compliance ever feel at odds with the speed of the startup, right? You know, you've got these plans, you got a strategy, you know, where you want your operations to go, but the regulations are sort of holding you back to some extent. I mean, I'd imagine some of the areas that cause issues around regulatory compliance might include recruitment of clinicians, which you've talked a little bit about from different specialties in different states, or advertising, privacy that we've mentioned and, in particular, given what you all are doing, controlled substance prescribing.

Amber Gill: It definitely can slow us down. I would say compliance doesn't just slow us down, but it also shapes how we build. And that is important, especially in healthcare. And we're constantly making decisions about growth, product, partnerships, hiring and patient experience. And in telehealth, every one of those decisions also has a compliance dimension. And that creates real tension sometimes. There are moments when the business wants to move more quickly, but the right answer is actually to slow down, assess the legal landscape and make sure that the infrastructure is in place first. That can feel like a constraint in the moment, but in reality, it is what allows us to scale responsibly. We rely heavily on legal advisors to help us understand not just what is permissible today but what may be changing around the corner so we can prioritize accordingly. That shows up in very practical ways. It affects how we attract talent across the states, how we think about independent contractor relationships, how we approach advertising, how we evaluate new technology like AI tools and how we support provider groups in areas like controlled substance prescribing. In ADHD care, for example, it has been critical for us to understand both federal development and state-by-state restrictions so we can build the right safeguards into the platform. Advertising is another great example. From the outside, marketing can seem simple, but in healthcare, there are additional layers of scrutiny around claims, consumer protection and how services are even presented. So we have had to build a much more compliance-informed approach to growth than a typical startup might. But just because it slows us down, that's not a problem. It does help us provide safe care, which is the most important part of our business.

Shalyn Watkins: And it makes me as a lawyer start boning up a little bit more on the things that I never really thought about, right? When I started my practice 10 years ago, I didn't think I would ever have to look at what does it look like to have a social media platform that includes, you know, ads from influencers and what, who is an influencer? Is it somebody who has just like 500 followers on Instagram or what? Because, you know, the thing with our telehealth clients, you're hitting the cutting edge of the market in every way possible, so you're also reaching end users differently than any of our healthcare providers were doing before. The most we would see in the past would be maybe a static post on Facebook that would have a hospital's, you know, picture on it with no words. And now we're like, OK, how long is this TikTok video going to be? Who's speaking? Did anybody write a script for this person? What are the conditions for them being paid? And what are the things that they're going to be saying? It's a crazy new world that I think keeps us all a little young.

Morgan Ribeiro: Shalyn, anything else you'd add to those areas of compliance or any reaction to other things that Amber mentioned?

Shalyn Watkins: I definitely think the controlled substances piece is something that I've seen a lot of movement here in the past year or so because, basically, under federal law, we've been working under these extensions every year since about 2022. There were extensions of COVID-19 policies and procedures for prescribing controlled substances via telehealth, and at that point, it was a necessary need, right? There was nobody able to get out to go get their controlled substances. But now, since we're kind of integrating telehealth as a normal facet in the community, the federal government hasn't finalized any rules. They've been kind of teasing us with it, and states are then, in turn, also reacting and they're creating their own internal rules that we are kind of struggling to keep up sometimes, and we're always kind of watching it. And I think that's something that a lot of our telemedicine and telehealth clients are focused on very, very wisely these days.

Morgan Ribeiro: Shalyn, I think just kind of continuing along with that, looking ahead, right? I think this kind of momentum and the speed at which we're seeing change, yes, the regulation is still far behind where the technology and the kind of overall care delivery models are advancing. But what's one trend in healthcare enforcement that telehealth leaders should have on their radar right now?

Shalyn Watkins: I think AI is something that everyone should keep in mind. How are we integrating it? This is no different than what, you know, our brick-and-mortar clients are seeing. I kind of have been getting to the core of things with my telehealth clients. I say, let's not forget, let us step back and realize that all of the regular rules apply to us, right? So, when we're talking about integration of AI, we often end up also considering licensing requirements for any of the clinicians that are working because they are going to implement the AI in their care coordination, right? So, if a state has said it's generally OK to have AI that is recording and dictating a conversation between a provider and an individual, then that is something that is usually governed by the state licensing board. And we have to go back to our roots and think about protecting the individual's license because their license is what allows the business to stay afloat. You need licensed providers who do not have discipline in order to provide quality care. And so, while we're waiting for more guidance on laws like what's happening in AI implementation or in advertising or even in the corporate practice of medicine, I've been telling clients, let's just go back to our roots and think about the things that are always going to stay consistent throughout all of this, and it's going to be the core, the key component of licensure and certification.

Morgan Ribeiro: I definitely agree with that. I mean, I'd be curious, Amber, just from where you sit, kind of piggybacking off of what Shalyn said, is there anything sort of on the horizon for your company that, in terms of how that intersects with regulation, that's sort of keeping you up at night?

Amber Gill: I don't know if it's keeping me up at night, but there's so much talk about AI, and that's always very interesting and very exciting, but we're very careful about how we approach it.

Shalyn Watkins: Especially if it comes to diagnostic tools, right? We can use it for administrative purposes right now. We know that. But how close can we get to the edge is becoming the modern question.

Amber Gill: Right now, just administrative support. We haven't even touched on incorporating it on anything clinical.

Morgan Ribeiro: Awesome. Well, I appreciate your time today. Always fun to connect with you, Shalyn, and great to hear more from you, Amber, on what you all are working on at Receptive. It's very exciting, and I think there's just so much opportunity. The industry is ripe for growth and innovation, and hopefully the regulations will soon catch up with all of that. So, thank you, guys.