Join host Dr. Leo Damasco on Telemedicine Talks for a solo episode reflecting on the key trends in telemedicine from 2025 and what to expect in 2026. From business shifts and regulatory changes to AI integration and physician empowerment, explore how the industry is maturing and evolving for better patient care.
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What shaped telemedicine in 2025, and what's on the horizon for 2026?
In this special New Year episode of Telemedicine Talks, host Dr. Leo Damasco recaps the year's major developments, including the shift from broad direct-to-consumer platforms to focused enterprise partnerships, heightened focus on compliance and accreditation, clinical standardization, physician leadership, and AI's role in care. She discusses Medicare flexibility extensions, legal scrutiny, and predicts continued consolidation, hybrid models, and stricter regulations in 2026, emphasizing opportunities for innovation and better governance.
Three Actionable Takeaways:
About the Show:
Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine.
About the Host:
Dr. Leo Damasco – Pediatrician and emergency medicine doctor turned telemedicine advocate, helping physicians transition to digital health.
Connect with Leo:
leo@telemedicinetalks.com
[00:00:00] Hey everybody, welcome back to Telemedicine Talks. This is your host, Leah de Masco. Thank you for joining and hey, happy New Year everybody. 2026 is upon us. I can't believe it that happened so fast. first I just wanna say thank you to all the listeners out there. that are listening now and that have joined us, especially from the very beginning.
You know, Phoebe and I started this podcast in February, 2025. It was really just, hey, we just wanted a forum, a mode to just talk about telemedicine, share what we knew, and get people on to talk about the telemedicine environment and to share kind of the knowledge out there. we've had
some great people on and we are looking forward to continue that in 2026. We're super stoked, super excited. Our January 20, 26 calendar is full and we're excited to bring more of this telemedicine talks to you. So thank y'all for being with us and getting through [00:01:00] 2025. so really right now.
given the new year, I just wanted to take this episode to talk about and reflect what we saw in 2025 and maybe talk a little about, what to expect and what to look out for in 2026. So let's get with it. So, 2025, if we could sum it up in a few words regarding telemedicine.
I would describe 2025. As a year of reflection, accountability, and maturity. So really when telemedicine blew up in the pandemic. Right. Telemedicine's always been there. It's been here for decades. You know, we've talked to people who started up telemedicine practices decades before the pandemic, but.
We saw this huge boom during the pandemic, right? And it was needed, right? we couldn't see patients, doctors couldn't see patients, and patients couldn't get their care in person because we're all, confined to our own six foot radius, right? And [00:02:00] telemedicine was a needed modality.
To provide that essential care. Laws were changed, practices were changed. Businesses popped up, and you know, doctors started changing their practices started transitioning to solely telemedicine and started making money for it. Right. Now when the pandemic started dying down, started fizzling down and people started to migrate back to their pre pandemic practices being seen in person, you know, brick and mortar locations.
What we saw was telemedicine kind of retracting a bit, right? And in 2025, we saw a little bit more of. I wouldn't necessarily say a retraction, but a change. Right. And during the pandemic, what we saw were creations, which is a big boom of a bunch of telemedicine platforms that offered direct to consumer care, urgent care that had really no focus, just kind of just provided broad [00:03:00] care.
Right. Come and get it. Hey, we provide any care. All care. And in 2025, what we saw was that these practices, these platforms that provided direct to consumer care are actually struggling. And actually some quietly just went away. They just fizzled out. And what we saw was that a transition to more focused care and not just that.
Instead of direct to consumer care businesses started transitioning to enterprise partnerships with payers, with employers, with location cities, And, yeah. and this was needed, right? Um, we saw Teledoc move further away from growth at all costs and move towards enterprise partnerships.
Amwell started leaning deeper into health system, embedded virtual care. So yeah, gone are, I think, are the days of these broad base, unfocused, direct to consumer care and now focus care. Right? You saw that too with a specialized care. Platforms, you [00:04:00] know, hims, hers, you know, they started banking on their verticals, started expanding their verticals.
And things like that. you know, um, that's a big change. Um, another thing that we saw in 2025 was this focus now on compliance, governance, standardization, accreditation. You know, and this is a nod to Phoebe, right? you know, and she's always been preaching, hey, compliance, standardization, and rightly so, In the wild, wild west time of the pandemic, these businesses were stood up and just started going, started practicing, but the framework for governance compliance wasn't set up. So you had all these businesses doing things and, and not necessarily being regulated. Right. And they could do. Kind of whatever they wanted right now, the, the doctors were there practicing and you know, it was up to the doctors to provide care, but they didn't necessarily have the framework to be supported for that, or there's just no framework at all.
So it was just [00:05:00] whatever happens, happens. Right. But what we saw in 2025 was that telemedicine no longer flying under the radar of regulatory care, or the regulatory oversight. Right. We saw The regulatory bodies focusing on telemedicine, focusing on accreditation. companies started formalizing peer review and credentialing processes according to like NPDB, right?
Companies started getting accredited using like URAC accreditation to becoming more formalized, States started focusing on these PC MSO relationships, right? Um, trying to make sure that hey, actually the clinicians are running the u the practice groups and not necessarily the corporations, right?
Uh, are, is, who's doing the hiring, are their clinical standards set up? Prescribing audits started going right. And this was reflected by kind of the legal things that we saw. The lawsuits that we saw in the legal actions. Right. we talked about it in a previous episode talking about the done global and the [00:06:00] cerebral platforms.
facing lawsuits and Facing both monetary and even jail time. For, poorly controlled, um, prescribing practices. we're starting to see PCMO structures being shut down. Right. And especially in California being, um. Being more scrutinized because, they're starting to see that, some of these relationships were just pass throughs and the PC owner wasn't actually involved.
Right. You're looking into billing, marketing and claim scrutiny too. You know, investigations into billing practices, employ contracts. Also looking into hipaa,and privacy. before you know, it was just kind of willy-nilly and just just the second thought, but now, compliance and these regulations instead of being nice to have is now business critical.
And I think we're gonna continue to see that. Now in kind of the same vein, right? What we also saw was clinical standards being applied to telemedicine as well. like I was saying [00:07:00] before, when you know, these telemedicine practices were started up, you know, it started up so fast, they just relied on the clinical practices of the physicians practicing.
Right? There wasn't necessarily standardization and I saw this when I was practicing. and this happened a lot in. It's kind of the urgent care real, Hey, it's just, hey, you practice, like you practice, in brick and mortar. But now what we're seeing is more, Clinical protocols, being enacted.
a good example is Amazon Clinic. Amazon one. If you haven't, been on that or worked on that platform, they have very strict inclusion exclusion criteria where you have to stick closely to it. Not just that, even if they meet the inclusion criteria initially, there's certain specific pathways that they want you to follow.
and personally, I agree with this, right? telemedicine is not necessarily just like brick and mortar, and there's a lot of times you have a lot of different providers providing care to the patients on these telemedicine practices, [00:08:00] and these telemedicine guidelines provide a good framework for that, right?
What we saw without these guidelines is just non-standard care. just care that. one person doing one thing, another person doing another, and the patients don't know what to expect or, um. Can have contradictory care. But I think with these more, with the focus on the platforms and the guidelines, now you have these standards that the physicians practicing can rely on and can fall back on.
But also, the patients also have clear expectations of what we can and cannot do in telemedicine. And I think that. That is super important, especially, in a practice where we treat all types of patients, all types of physicians jump on and it's treated across the nation, right?
and I think it also instills a sense of trust, right. instead of, non-standard care where. Patients get care one way and one, you know, with [00:09:00] one provider versus the other. The standard of care kind of instills this sense of trust and, and validity in the practice right now.
I think another thing that we saw too was, empowerment of the physician within telemedicine. what you saw was. I think more physicians transitioning to telemedicine,
as part of their primary practice. a lot of times it was, their side, you know, their side gig. But what you saw a lot is that doctors are now seeing that, Hey, I could create a career out of this. And they're incorporating telemedicine more and more into their practice. And not just that, I think the doctors now in telemedicine are realizing that they have a voice and that they have leverage, and that they can use this voice and leverage to create working environments better for them.
Pay compensation structures better for them. there what we saw was [00:10:00] some pushback against kind of just opaque compensation models, sometimes unsafe visit volume. So the physicians were actually dictating the care that they were giving and how they were getting paid. But also what you saw too was a lot of physician-led organizations, Also doctors. Taking the medical director roles and really also becoming ownerships. You were seeing, more and more, I think doctor entrepreneurs taking ownership structures and, these platforms too are seeing the value of this, right? they are realizing that, hey, you know, physicians.
are a huge asset to your company. And actually they value getting a physician on board and being part of their leadership structure. And I think this is a good thing. and I've talked about this before, and in brick and mortar space, we've lost leverage. We've lost our leadership roles.
We've given it up because we wanted to focus more on care. I've seen this a lot. [00:11:00] You see this in big health systems. you see this in practices. You know, the doctors were thinking that, Hey, we didn't need to do the, to the business side, we were just all medicine. We'll have somebody else do it. But the side effect in that is we've lost leverage, right?
We've allowed other people to become leaders in that space, and now in the brick and mortar space, at least. The care that we deliver and how we deliver it is dictated not by doctors. I think in the telemedicine space, I think it's still new enough. And I still think it's still pliable enough where doctors have now come in and have taken up those leadership roles.
And I think as long as we continue to take up those leadership roles and seek those leadership roles, I think we'll still be able to dictate care and be leaders in this space and not, and not give up that leverage. So that's nice to see. being a doctor and being a medical professional actually became an advantage.
and the platform saw that as a [00:12:00] competitive advantage. They saw our value, and,2025, you know, we can't ignore ai. Huge. Huge, right? We see this. Out in any, any other sector, right? AI is huge and you know, you saw AI getting into telemedicine, right? You know, you, if you went to the big conferences, a TA Health, AI was.
first and foremost. You know, and it struck me when I was at health this year, you know, this is an arbitrary number, but the majority 80, 85%, I don't know . the point is the majority of the people out there of the stands of the talks were talking about ai, you can't escape it right now.
Most of the times, you know. You don't even know. AI's running a lot. Most of the times, the AI's actually running in the background of these platforms. You know, they're either running the front end of it, getting, taking calls, doing [00:13:00] triage, so forth and so on. But they're there. But also what you're seeing is creep of AI into the actual patient care.
You know, you see a lot of these platforms that are suggesting diagnoses that are suggesting. Kind of care modalities or you know, the management to the doctors. But what I've also noticed is that there is, I think, an appropriate, but a good amount of pushback that is disallowing AI from actual providing the totality of care.
Right? What we don't wanna see, what I don't wanna see. Is AI taking over care altogether . And that's a big concern, right? That AI is going to push us out of our jobs, right? AI could do a better job of that. And I think that, you know, the leaders at B and the physicians have done a great job at making it a point to say that AI [00:14:00] can't do that, right?
We're gonna need. Actual people dictating care and actual people, you know, making the final decision. We can't necessarily have ai, providing the totality of care. And I think we've seen that. the attempt to replace clinicians outright. Isn't there? It actually kind of failed.
and I think as physicians we need to continue that front, right? This is why we went to school. This, you know, AI can't necessarily replace kind of the in-person thinking of experience that we have , right? so yeah, that's 2025. Now, what do I think that 2026 is gonna look like?
I think kind of continuation of what we've seen in 2025. Right? So in terms of business models, right? I think again, the broad based urgent care platforms out there, that. Relied mainly on, or, started with a direct to consumer [00:15:00] focus is largely gonna go away.
you know, these broad based, direct to or broad based urgent care platforms will continue to need Payers will continue to need private insurers, Medicare, medicaid, enterprise kind of relationships to continue to survive. And we're seeing that, right. Um. When I was starting to work, on these urgent care platforms, yeah, they were all direct to consumer, but now there's a big push to partner with the payers, right?
And you're gonna see that now. I think what we're gonna have to be careful about is to ensure that, you know, when we create these relationships that, that the payers or whoever we have relationships with, is. Paying or compensating the telemedicine practice appropriately. So that's I think is gonna be a struggle, in 2026
Now, let me rewind, 'cause I totally forgot about one big thing that [00:16:00] happened in 2025. let's talk about the Medicare. extensions, right? we're talking about these Medicare extensions, right? So we've talked about this a lot, right? and these Medicare extensions, during the pandemic.
pre pandemic, let me rewind even more. Pre pandemic, you know, telemedicine was not paid by Medicare. and there was only specific instances that Medicare paid for telemedicine. You had to be in specific location, specific people had to provide the care. You know, the patients had to meet specific criteria and with the pandemic, these rules were relaxed.
And the co, you know. Telemedicine flexibilities. Right. And Medicare was now allowing people to be seen through these telemedicine, platforms also, you know, controlled substances. you could get through telemedicine. Now these rules were set to expire and they, every year after the pandemic, they were set to expire, you know, and they were set to expire around September.
But, every year these rules were [00:17:00] extended. And this year, this was supposed to, uh, 2025 was supposed to expire in September, and just like prior years, it was expected to be extended out, but because of the government shutdown. These flexibilities were not extended and this actually created problems,
people expected this to be extended and it wasn't. And immediately there was fear that Medicare wasn't gonna pay out telemedicine practices. And so platforms started or stopped providing. care to Medicare patients, investors stopped investing into platforms, especially Medicare heavy platforms, and it created a problem.
Also, there was a threat that all these patients that depended on. Telemedicine couldn't get their care. Now, once the government opened up, these telemedicine flexibilities were extended but only temporarily. Most of these flexibilities were extended only until January, 2026.
Right now, the [00:18:00] controlled substances,The controlled substances deal was extended out through December 20, 26. So that's out of the table. But the other flexibilities, who could see the patients, where you could see the patients, what types of patients could be seen?
Were only extended out through January, 2026. Now everybody expects these flexibilities to be extended, right? Telemedicine has proved its worth and, Taking out these flexibilities would be a big blow for patient care. and people, I think overall wanna extend these out. I think everybody thinks it's a great idea, but I think the hesitancy is the lack of still oversight framework.
there's a hesitancy to make this permanent because there's not a good oversight framework to make sure that this is done correctly. So I think that these flexibilities are continued, are, are going to be continued to be pushed on down the road, you know, pushed until maybe the end of the year, so forth and [00:19:00] so on, which is good, but you know.
There's always gonna be a question mark overhanging it. There's always gonna be an uncertainty, right? And so, you know, and I think this is gonna continue in 2026, right? I think this is gonna, be a factor in, companies fully investing in telemedicine, into companies, fully going all in, into, um, providing care for Medicare patients.
you know, that's, that's another thing that we're gonna see in 2026. Another thing I think we're gonna see in 2026 is kind of furthering of the rules, further tightening of the scrutiny of accreditation. Regulations, so forth and so forth. You know, the regulat, the regulators are moving towards clearer and stricter guidance.
so the companies that actually spent money in compliance, you know, and actually made an effort in the front end are gonna have an advantage. And the companies that didn't work are going to need to catch up, it's not gonna get easier [00:20:00] for them, but it's gonna get clearer, right? There's gonna be, uh, more definitive.
Standards that are gonna be applied now. , One thing that I hope to see and I, want to see in 2026 is this idea of physician leadership. I think, we have realized that hey, we can be leaders in this space and I hope to see that idea grow, I wanna see more physician entrepreneurs, starting up, these companies, um, more physicians taking these leadership roles in the C-suite, right?
I'm looking forward to seeing that. And, also, and we mentioned this too, integration of telemedicine, right? Deeper integration within health systems, employers. locations, FQHCs, you know, talking about that there's, the big grant that's out there for rural health.
I think telemedicine can play a huge role into that. And, what I hope [00:21:00] to see is people tapping into funding sources like that to help further telemedicine, especially in rural places. Also what I think is gonna happen is there's gonna be more hybrid care, opportunities or more hybrid care, practices out there.
So not strictly telemedicine, not strictly brick and mortar, but, these brick and mortar, practices can expand their footprint using telemedicine, can make their practices more efficient. So I think we're gonna see more of that. instead of, this strictly binary kind of modality, I think, you know, we're gonna see more of a mixed care kind of environment.
what we're also gonna see and expect is that, the telemedicine environment. Becoming, not necessarily more efficient, but skinnier basically. again, there was this big boom and during the COVID times, right? And you've seen a lot of the businesses, seen a lot of business kind of ideas.[00:22:00]
And what we're gonna see is a continued consolidation. Of these practices, right? we're getting a better sense of what works and what doesn't, and we're gonna see more of the platforms that don't work, just fade away. And, the platforms that focus again on these relationships or focused more on focused care, providing only specific services are the ones that are gonna survive out in 2026.
there's gonna be rising expectations for, clinical standardization, rigor, governance. So I think those are all going to be dictating factors and who's gonna survive 2026 and who is it, you know, there's gonna be a lot better care, I think, and less noise within the telemedicine community.
yeah. So those are My expectations or what I think is gonna happen 2026. yeah, so. If you have any other ideas, [00:23:00] any other thoughts, please drop me a line. you could reach us at telemedicine talks at Leo, at telemedicine talks.com. Also, you could reach Phoebe at phoebe@telemedicinetalks.com.
we'd love to hear from you. We'd love to get you on the show. We love having, guests on just talking about their experiences, really just hanging out. This is more of an informal conversation, so please jump on the show. We'd love to have you on Drop us a line at info@telemedicinetalks.com and we look forward to having everybody listen, listening, and having more people on, and excited to get on 2026.
Thank y'all for listening and see you next time.