Health policy isn’t background noise, it’s the operating system of healthcare. In this episode of Telemedicine Talks, hosts Phoebe Gutierrez and Dr. Leo Damasco sits down with Sunshine Moore to unpack how payers, states, and regulators actually make decisions, and what digital health and telemedicine companies need to know to succeed.
Why do so many telehealth and digital health startups struggle when they try to work with health plans, Medicaid, or Medicare?
In this episode of Telemedicine Talks, Phoebe Gutierrez and Dr. Leo Damasco are joined by Sunshine Moore, who specializes in translating between startups, payers, and government programs. Together, they pull back the curtain on how health policy really works, and why understanding it is essential for anyone building or scaling a healthcare business.
Sunshine explains why direct-to-consumer telehealth models don’t always translate to public payers, how Medicaid and Medicare populations differ dramatically from privately insured patients, and why speaking “health plan language” matters more than flashy technology. They explore how states measure success using cost, quality, and access—and why metrics like HEDIS, network adequacy, and ROI drive coverage decisions.
The conversation also dives into rural health transformation funding, niche population strategies, employer benefits, behavioral health access, and why some of the most impactful healthcare innovations aren’t “sexy” at all—they simply solve real problems for vulnerable populations. From health policy history to practical advice for startups, this episode reframes how innovation actually happens in healthcare.
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 Guest:
Sunshine Moore Anger is a health policy consultant and former health plan leader who helps startups, providers, and organizations navigate Medicaid, Medicare, and complex payer landscapes. Known for her ability to “translate” between innovators and insurers, Sunshine specializes in population health strategy, public programs, and regulatory alignment.
📧 Email: sunshinemoreconsulting@gmail.com
🔗 LinkedIn: http://linkedin.com/in/sunshinemooreanger
About the Hosts:
Tags
Telehealth Policy, Health Plans, Medicaid, Medicare, Digital Health Startups, Population Health, Health Innovation, Rural Health, Behavioral Health, Healthcare Regulation
Hashtags
#TelemedicineTalks #HealthPolicy #DigitalHealth #Medicaid #Medicare #Telehealth #PopulationHealth #HealthcareInnovation #PayerStrategy #HealthTech
[00:00:00] Hey everyone. Welcome back to another episode of Telemedicine Talks. I'm so excited because we actually have one of my old bosses and honestly mentors. She's now a great friend, kind of stuck with me for life, sunshine, more anger, who is one of the few people I have met in my life that actually speaks my language.
Lobbyist health plan executive. I think we've even worked with the same people you know, I was a regulator and you were on the association side. But I got to meet sunshine when, working at a public health startup and
I've learned so much from you in the short time that we got to work together and I thought that you would be a great person to come on and kind of educate our audience a little bit about health policy and like why I harp so much that this stuff really matters. So, welcome. Thank you so much for having me.
It's great to see you. Yeah. And you're [00:01:00] always so sweet to flatter me. I learn as much from Phoebe as she ever does from me, so it's mutual. That's amazing to have you on. Yeah, and definitely on that side. Phoebe, I have my dictionary up on, on my other screen here. 'cause if she's speaking your language, man, I'm really doing a lot of dictionary lookup on what you talked about.
It's funny that you said that because I tell my clients, like I speak Health Plan, I can translate one way or the other, right? If it's a health plan that's working with a community-based organization and a community-based organization, there's brand new Medicaid benefits, but
They don't know how to take insurance, bill insurance, like comply with insurance. Or on the flip side, you're the startup and you're like, why won't a health plan buy my product or contract with me or do whatever? And it's like, because you're not framing it in words, they understand and words they wanna hear of what your value proposition is.
You're just talking about how great and wonderful [00:02:00] your product is, but you know, what are you gonna do for them? So it's funny that you said that, that I speak your language. That's what I was telling my clients. I translate between the two. We were talking about this Phoebe, that, you know, like doctors we're very focused in our own little sphere and globe.
And we expect everybody to be like, oh, just fall all over it because we know what we're talking about. But stepping out and it's also interesting that you've connected it to, you know, hey doctors reaching out and, hey, buy my product.
Nowadays, when telemedicine, blew up during COVID, it was a lot of direct to consumer. Right now it's kind of normalizing back to where now your business is going to have to deal with payers. Right. It's going to have to, and I think it's gonna shift mainly to that.
Yeah. You're gonna have your b D two C customers and those companies that thrive in that, but that's only gonna be a handful. Those that start up now and will thrive now will have to deal with payers, will have to deal with, Medicare, Medicaid. So, yeah. How do we talk to you all?
So I think you're right. A [00:03:00] lot of the telehealth companies started out as we'll. Do DTC first and then we'll do B2B. Yeah. But your audience and your patients are completely different. You know, when you're. G two C, it's disposable income. I'm gonna wear a glucose monitor because it's really fun and I'm gonna see what I eat and then like go write it down and I've got a Fitbit and that was me.
You know, those are the people with expendable income to buy the latest and greatest, those early adopters, right? The way the innovation curve works, when you're going to pitch to Medicaid and Medicare in particular, it's a completely different population. Not tech savvy, not an engaged patient. Sometimes don't even have the right phone number for those.
And they are the 80 20. Those are the people who account for 80% of the costs and the people who are, checking their glucose because it's fun, are not the people who are incurring any costs at all. And they all have private insurance. [00:04:00] And the segment of the population you are. Sales market, your TAM is massive.
If you're going after government pairs or in the self-insured market, it's a lot more niche. Firefighters need mental health services. I just was looking at a digital health company that they do cardiology and home blood pressure monitoring, things like that for airline industry employees because they're changing altitude constantly.
Right. So you have to tailor your message to, who you're trying to serve and not just, oh, this is so product focused or clinical outcomes focused. It really needs to be population focused. Everything in Medicare and Medicaid is population health, hard to reach populations, the 5%. So, and did you guys plan this out
we literally just did an episode earlier talking about how niche you need to focus this. a lot of companies out there are like, Hey, I'm gonna start, [00:05:00] this telemedicine business, and I'm gonna cater to everybody because everybody's gonna want my services.
But just like we were talking about earlier, you did the exact opposite. the great example, you know, this cardiac monitor just for airline folks. And they're gonna find success in that because it's just focused on that, you know, it's just tailor made to that you are going to have a market once you prove, that idea.
Yeah. And the product is versatile. Right. Absolutely. I mean, you can put the Heart monitor in this program for anybody, but their client is an airline, so they're gonna tailor their messaging to the airline. And so I always think it's interesting when I'm working with the health plans, one of the things that I do with my clients is they bid on state Medicaid contracts, right?
So I'm the state X and I'm gonna contract with five health insurance companies to administer my Medicaid plan and I'm gonna put out a bid. these are Fortune 10 companies are gonna bid on this contract and maybe only three of 'em are gonna win the contract, right? And these are billion dollar contracts and the state is asking.[00:06:00]
What are you gonna do about prior authorization to make it easier for doctors? they basically wanna hear that you're gonna get rid of prior auth on everything, but this is taxpayer money, so you really can't do that. It wouldn't be safe, understanding why that's important.
They wanna know what's your role? Healthcare strategy. They wanna know how are you gonna improve black maternal health outcomes. they have really specific things that they're looking for. And so telehealth is always a part of their strategy because there are provider shortages all over the country.
And you just can't, say we're gonna go contract with more doctors if the doctors don't exist. Nevada's a great one. You know, there's like seven dermatologists in the entire state and you've got five of 'em in your network. And one of 'em, you know, is on the Medicare blacklist and one of 'em, you know, is retiring, right?
So like you can't invent doctors. So if you have, skin mole ai, telehealth, something like that's gonna be a great part of their strategy to submit to their bid. But what I always think is so interesting is why do they contract [00:07:00] with so many different telehealth companies? Why is there one that's just for behavioral health and just for maternal health and this other one for, diabetes management and this other one.
I'm always just curious as a consumer, why not Teladoc? You know, why not just one and have 'em do everything, but it's because they wanna see just read something that was like, if you can't prove ROI in six months, you don't even get a year anymore. They wanna see ROI, they wanna see peer reviewed studies.
They wanna see that, you know, the percent of patient engagement. and that's the hard part, right? It's hard to prove because it is such a difficult population to engage in their health. Half the time you don't even have the correct phone . I will say 40%. I worked on the population health stuff.
40% did not have an accurate mailing address or phone number. And, who's the they in this particular matter? A low income person who qualifies for Medicaid, which again, is a [00:08:00] big population in the United States. And to kind of like add to that sunshine, I was the one on the flip side, reviewing what you guys would submit,
grading and scoring them. And to me it's like this is the interesting part about telemedicine, digital health, all these startups, right? if you listen to an executive team, they're taught what are the KPIs and what are this and what are that?
And they're making all this BS up for VC companies and whatever. The state operates the same exact way. So to launch a lot of these programs, they actually show you, this is how we're gonna score the contract. This is how we're gonna score the RFP, these are gonna be the metrics that we're monitoring as a state.
'cause you have to report them to us and we monitor that stuff. I mean we were very transparent with these are the metrics and how you measure success. And it's always measured on cost, quality and access. Can you keep the cost lower? Can you, still provide high quality of care?
And then are you basically expanding access, continuously [00:09:00] expanding access and making it easier for people to get care. And the way you measure access, right? When you're a health planner or a regulator, is different than the way a telehealth company might envision access. So you say, who are the people we're talking about?
In a state like New Mexico, 60% of the population is either Medicare or Medicaid, right? So these companies, you're looking at what are the federal regulations I have to comply with? You know, they're very focused like that. But when you break your market down, who are you going after? If it's California, a third of the state's population, which is 14 million people are on Medi-Cal, which is Medicaid.
So if you're going after California and Medicaid is not a part of your strategy, that's fine, but you need to understand it's not 40 million people then, And when you talk about quality, I mean, so doctors, no HEDIS measures. Yes.
Unfortunately, but I never see telehealth and digital startup companies presenting their pitch in terms of HEDIS measures. [00:10:00] And that's an example of you have to speak health plan language. They understand HEDIS measures. You might have a great, wonderful product, but if it's not what they get scored on by the state, they get fined by the state and they get incentives from the state.
They get rewarded. So you're improving nothing. No, you're improving something great and amazing. But if nobody's measuring it, what's the old saying? You can't improve what you don't measure the interesting partit's tied to everything.
Right. Like that's what questioned is like, it would be fairly easy to get A really solid contract with a health plan, if you could go, I could increase immunizations by X percent for This one population, 'cause it's actually public on the state's websites.
What every single health plan is measured at. Everything is like, you just gotta Google and look this stuff up, but you could actually see where there are gaps on health plan side. I used to monitor a lot of that when I was a regulator, but it was so interesting to me. 'cause you can actually find care gaps.
[00:11:00] You can find deserts, you could see what health plans are being fined because they don't have this type of provider in network and they should. so it's really interesting to me, you know, to Sunshine's point, it's like, yeah, there's NCQA, there's, HE DDIs, there's a few others that are the satisfaction scores that I'm drawing a blank on?
Yeah, you need cats for satisfaction scores. you know what I mean? Like, there's all these things that are actually public. So you could in theory just align with where you see people are failing. That's actually an interesting thought. You know, I've actually dealt with a telemedicine platform that I thought it was a great idea.
I still think it's a great idea, right? But when we were trying to get in line with health plans or try to, you know, basically do what you said, convince health plans to bring us on, that was one of the first things that came up. Hey, what HEDIS measures are we helping them out with what is a value add?
And to us, our value add was like, Hey, you know, we're keeping people outta the er, right? But I [00:12:00] always think that's a great value add, but no, it's not a HEDIS measure, right? It's not , you know, it was, Hey, what. Maybe, maybe, and that's the thing, right, I was just joking with Phoebe the other day that that's the thing in healthcare right now is anything that remotely relates to reducing ER and inpatient admissions, then my health plan should cover it.
So Medicare and Medicaid, let's cover transportation because if you can't get to the primary care doctor's office, you're gonna use an ambulance or show at the er. Let's cover fruits and vegetables because if you're eating healthier, and so those are great. I'm not saying that those shouldn't be covered, but you know, rent, I mean a lot of these programs, the logic is it will reduce ER visits and inpatient stays.
I used to always joke that my health plan should cover my Vitamix because I have a $400 [00:13:00] blender that completely changed my life. And when I was a lobbyist my boss used to give out the mandate of the year award. So a mandate bill is when a legislator introduces a bill that says Your health plan must cover, four D mammography screenings.
'cause that was a brand new technology and it was a better way to do mammography. And the standard was 3D and health plans would only cover 3D. And so let's introduce a bill because, private insurance is covering four D, but Medicaid's only covering 3D and that's not right. And everyone should have equal access, right?
That's called a mandate bill. So my favorite mandate bill of all time was Hawaii, introduced that health plans should cover traditional Hawaiian cultural activities, including, but not limited to luau, hula dancing. Paddle boarding, you know, all [00:14:00] these activities that would reduce chronic disease and obesity.
And, my health plan should cover equestrian therapy because horseback riding helps with opioid use disorder, right? All these things. So she used to always say like, this one takes the cake. So one year I had a trophy made of a slice of cake with a fork stuck in it. And then I presented it to her for the mandate of the year.
'cause this bill takes the cake. And the winner that year was Hawaii. Is it still going on? I need to tap into that. You make too much money, man. Yeah.
So if you wanna come up with a digital app to, connect people to Native Traditions, again, not saying I think it's a great idea, our policy makers decide whether health plans have to cover it. Yeah. so I think sunshine, like one thing that, I harp on,I was on the state side where something dropped.
I just have to go and, we have this new benefit or this new policy or whatnot. I think you were closer to kind of the actual like lawmakers, you know, at the capitol. [00:15:00] But, I think one thing that I think would be really interesting for our audience to understand a little bit more is like.
How do these things actually, like what is the process and secondly like why should everybody care about health policy? Because again, like I care about it. I know you care about it. So many people, again, when we think politically, I don't think too often we're actually thinking in terms of the stuff that actually happens.
No, it's a good point. I do think that you know, people complain about compliance or this is a dumb rule, especially if you're an innovator. your whole goal is the system's broken and I'm gonna fix it 'cause we have to do something different. But then you're in a highly regulated market and you don't always understand the history of why things are the way they are.
Some of it is archaic and needs to be monetized. And some of it is because there was a real story of a bad thing that happened to someone and, they went to their congressman, they went to their state [00:16:00] legislator and said, we need to fix this. sometimes with, Some of the like, credentialing things, for example, right?
Doctors all the time investigated by the OIG or blacklisted from Medicare for billing for people who were not alive anymore or, didn't actually go to medical school and had been practicing for 20 years and no one knew and someone got injured. so I do think it's good to understand that sometimes laws aren't just there to be annoying.
They're also there to either protect consumers or, protect doctors medical malpractice laws. tort reform is a popular topic across the country and that affects your insurance premiums when you're a doctor and it affects your insurance premiums when you buy health insurance as well,
that all gets built into the cost. So, yeah, a lot of times it's four D mammography. For example, if there were people whose cancer was caught late and could [00:17:00] have been caught sooner, but they only had a 3D and like I said, now you have this two-tiered system where maybe private health insurance was moving that way anyway because you pass it, we'll price it.
That was our motto. You can make us cover anything you want us to cover, but it's all gonna get built into the premiums. So a lot of times what a legislator might do is introduce a bill and say, this bill applies to everybody, every market. Then the fiscal note from the state says, this is how much it's gonna cost Medicaid if we cover this.
And they say, oh, no, no, we'll take Medicaid out and give them an exemption. 'cause that's taxpayer money. So now it only applies to commercial insurance. and so then you end up with a two-tiered system where some people have access to, a GLP one. I mean, four states just came out and said, we're not covering GLP ones anymore.
It was this big fight to get them covered and now they're rolling it all back because, we've got budget shortfalls in a bunch of states this year and the impacts of the one beautiful Bill Act in Congress. So it is [00:18:00] always good to understand the history behind different compliance rules or different laws that get passed.
And if you're a company that has a new great idea and health plans don't wanna cover it, go sponsor a bill to force them to cover it. Right? We see that happen all the time. You build your customer base. We saw that with COVID a lot too, right? So that's interesting. So you see that often. what's another good example of that?
And 'cause a lot of times these startups come up and like, hey, this is a great product. They don't know how to approach it. That's an interesting approach. what else can people do to help them see more appeasable to the payers, to the health plan, so forth and so on.
Yeah. So definitely speaking their language and framing your value proposition in a way that they don't like. What are their needs and how are you filling that need? Right. That's the basic and like I said, understanding your different markets. I think sometimes they just [00:19:00] think globally and don't always look at so health plans, even if you're a giant national corporation, you are regulated in every state that you're in and every market that you're in.
So Medicare, Medicaid, and then your local state. So United Healthcare in New Mexico is not the same as United Healthcare in Illinois and. UnitedHealthcare Medicare Advantage Illinois is not the same as UnitedHealthcare Medicaid, Illinois, right? I mean, insert any of the Big five. And there's also a lot of local plans, a lot of regional plans, so many Medicare Advantage plans.
And I think a lot of digital health companies start with Medicare Advantage as their, I mean employer always employer union. I think employee assistance programs and sort of these fringe benefits is always a really interesting way to go because then it's not really part of the health plan you're selling directly to the employer.
So I've seen a lot of fertility, digital health, [00:20:00] that's an add-on benefit that may not be required to be covered. But employers are still recruiting candidates by, you know, what we offer paid family leave, fertility benefits, The other interesting thing is I work with a behavioral health company and I ask them, why would anyone use their employer assistance plan for mental health when we have mental health parity laws?
And your health plan must cover, mental health. At the same way they cover physical health. And I didn't really understand this before and they explained it to me, is that when you go through your employee assistance program, it's private. It doesn't go into your electronic medical record, it's not run through your health plan.
That claims and paperwork isn't there. It's just I need, you know, typically it's like they'll cover six sessions of counseling per instance, per year. So I'm having an issue with my husband. You get six sessions, oh, now I'm having an issue with my child. You can [00:21:00] get six sessions. That's interesting. And I never thought about it that way, is why wouldn't you just go through your health insurance and there's actually a really important point there about access. So I have a friend who used one of the telehealth companies that does the LPs. Fill out this form, click, click, click, boom, you get a prescription. Leo probably signed off. It was, my name's probably on that lap. they also advertise that there's an oral option.
Now there is a brand new oral GLP one that just came out, but this was before that. And I kept trying to figure out, well, what's the oral medication they like? They didn't say they want you to put in your email address and they wouldn't say, but I had a friend who used that company and I was like, can you tell me what the protocol is?
I wanna know what the medications are. She didn't even really know what she was taking, but she pulls up her app and she's like, I'll read 'em off to you. So she tells me, and I'm like, okay, I know what that is. They're doing a compound pharmacy. They're doing off label. They're adding in like a B12 supplement.
[00:22:00] That all makes sense to me. And so I thought to myself, why wouldn't you just go through your health insurance and get your $5 copay? why would people pay $300 a month for a telehealth subscription based service that they don't even realize is for a generic drug and not a GLP one?
And it's because if you're sitting at home watching the Super Bowl and an ad for an ED thing comes on and you can just fill out a form and nobody has to know, and I listened to your bicycle health episode and I thought it was so fascinating that someone who maybe knows they have a problem and in a split second thinks I should maybe do something about this, that they can get a prescription for Naltrexone or whatever it might be in two to four hours versus.
Going to their doctor, getting a referral, having to go stand in line at a Suboxone clinic, which doesn't feel very good if you know, you feel like I'm not a drug addict. I'm a regular person with kids in a [00:23:00] job. And so the digital health companies often can find a market in the direct to consumer because
We make it as easy as click of a button, go outside your insurance. You don't have to go through your primary care. No one's gonna deny it. The transparency of the pricing, it's mailed to my house. So that's why they do, but then they struggle because they can't make that transition to the public payers because of the cost and because of not understanding the consumer base and the needs.
Those are very different, niches of, weight loss medications, a lot of the mental health companies, really just do basic depression screening And generic antidepressants, but they don't treat bipolar, they don't treat schizophrenia. They don't treat all these things, and that's what the health plans need.
They don't virtual counseling and a Prozac prescription. Well, no, it's interesting.I've been, toying with different ideas of the way that, you know, when I was at the [00:24:00] state writing policy, especially when it came to some of the clinical policies, we were really trying to set things up from a patient safety perspective.
You know what I mean? So it was like, these are the right ways this is the right step therapy, these are the right things you have to do. So at the very end, I worked on, the transgender policy, not to. Talk about a really political topic, but I spent a year on it and it was like, for the first year you have to do these therapies.
It's like all mental health. And then from years, you know, two through four you have to do this thing. And then, year four through five this thing, and then finally your surgery would get approved versus like, now, you know, you can just pay cash and get whatever surgery you need. And then there's this interesting thing where, you know, people are not happy with different therapies again, I have issues with the GLP one industry because I do think it's way too easy for people to get them.
And I wish that there was a little more friction and tension there because [00:25:00] I think if you could give me a pill or force me to go outside and run, I'm gonna take the pill if I have the money.
the things that you're talking about, especially with some of the startups I've been working with, this is what they've been trying to navigate over the past few months. You know, changing from direct to consumer to navigating health plans, navigating, what state needs payers.
There's a big question mark. How do we do it? What ideas do you have? Where do we start? You know, what's a good place? You know, nobody's ever asked, I don't think maybe I was in the wrong meetings. I don't know, What are the health plans needing? What are they actually looking for?
How are they getting measured? And not just, okay. the company was dealing with Medicaid, and nobody ever asked, Hey, what is the state? You know, going back to the state that they're practicing in what is the state needing, right?
Because whatever the state needs the health plans are gonna tailor to that. But nobody ever asked that question. And they were basically jamming a round peg in a square hole. Like, we have [00:26:00] this product, I think it's a great product, you need this product. But in the state eyes and in the payer eyes, no, we don't need this product.
We want this product. You know, and are you gonna meet our need? Not the need that you, the company perceives that we need, but the need that we actually are looking for, or are what we're gonna get paid for, what we're gonna get measured against. So really just reframing kind of the approach is interesting to me, right?
Like instead, you know, going back how do I find out what the state needs? How do I find out what the payer needs so I can make myself as a startup, more marketable to the payers and in turn more marketable to the state so my product actually takes off. Yeah. Okay. So here's the thing about government programs.
even though they are very archaic, one thing that's great is they're public. So in the private [00:27:00] market, you may not know who's shopping around what they need. If I'm meeting with the firefighters union, or I'm trying to pitch to an airline or a tech company mm-hmm. Like, you should contract with us.
The state. Everything's on their website. Everything has a press release, everything has a work group. Everything has hearings, so this is all publicly available information. Health companies often do not have time to do market research, competitive landscape analysis. That's the stuff that I work on.
Phoebe's worked on that before. I have the time to do that stuff. And so I'll give you a tip. Rural health transformation. Yes. The federal government is investing $50 billion. Right? And this is a great space for digital health companies. Every state, if they wanted to get funding, had to submit a plan to CMS, the Centers for Medicare and Medicaid services of how they would spend the money and the awards are publicly announced.
Press release is going out and the states now have to figure out how to implement. The plan that they [00:28:00] said, if you give us money, here's what we'll do with it. And as Phoebe mentioned, Even the state is BSing their answers when they're applying for grant funding.
I work on these projects where I'm a writer and we always say, Hey, we're building the plane as we're flying it. You know, my client has to answer what their rural health strategy is and I have to write it, but they don't know what their rural health strategy is. So I'll just make some stuff up and then you tell me whether you can go make that happen.
We're gonna write what sounds really good, right? And we know we have the money and we'll figure out how to do it. Even if it's using the most bandaided stuff together. But I think that's why I'm a little crazy and I enjoy the startup life. 'cause that's what I got to work on when I was a regulator with all the special programs of like, go operationalize.
We just got all this money, go figure out how to do it. Every state has urban health access issues. Every health plan has access issues, but they all have their own. Kansas has a need for subacute mental health and they're trying to figure out how to address that.
governor a child with autism and the [00:29:00] wife is on the board of a whole bunch of autism groups. And that's what they're passionate about. Everyone's got their pet project. The senate majority leader in this state or the house minority leader in this state, half of 'em are doctors.
Usually who sit on the health committees and they've got what they care about. And the states have publicly said, if the federal government gives us this money, here's how we'll spend it. So go figure out how to help them do it right. Say that you're gonna do it for cheaper. And then the other thing is.
With telehealth, everyone's trying to do this balance of, for example, health plans have to meet network adequacy requirements. They have to have enough doctors within a certain number of miles or minutes from the places where the members live. And Telehealth can supplement your network, but it can't replace it, right?
So with the rural health strategy, a lot of it is also, you know, the percentage of mental health providers who still use paper records, I think is like 90%. they're not using electronic [00:30:00] medical records. So when behavioral health is a really big issue, especially in rural areas, and then, you know, rural hospitals, so that's your B2B business as well.
It's not just the payers, but the providers delivering the care and how can you help make their jobs easier? Their lives easier. They're all getting funding cuts. They're all at risk of closure. So is there a market for your. Business there. Doctors supporting doctors. Right? So as a telehealth company that it's actually, it's funny that you mentioned the Rural Health Transformation grant.
'cause I was looking into that and actually working with a company to hopefully tap into that. Do you go after the state? Do you go after the payers? Who do you talk to? there's so many choices. Or do you just go pedal your wares? Right. You know, you go up and you talk to whoever is willing to listen to you.
You do have to kind of read every state's unique. So Phoebe brought up counties a moment ago. So some states, they're gonna be distributing the funds through some kind of a county [00:31:00] program. Some of the states are using it through K 12, so like digital mental health. And K 12 is huge right now, right?
But there's also other kinds of K 12. So you have to kind of go and see how they're intending to spend it. Are they dispersing it, you know, through a new Medicaid benefit, that would require them to apply for a federal waiver potentially. You know, there's so much work requirements and community engagement requirements, right?
So a lot of companies are, even if you're a red state, blue state, you don't like it. We all have to comply with it. So here's how we can make sure that if you need to get connected to a volunteering opportunity so that you can demonstrate that you meet the requirement. or I talked to one company where if you've had opioid treatment in the last six months, I think you're exempt from the work requirement or if you're actively involved in opioid treatment program or something like that.
So for the unhoused population who often have co-occurring either substance use or mental health disorders, like how can we just, I don't [00:32:00] wanna say check the box, but like how can we make sure people aren't dropping off the roles because of procedural or paperwork or lack of documentation? And there are a lot of things that can qualify as a work requirement or community engagement requirement being enrolled in class or, volunteering in your community.
So I just mentioned that as another example of you really kind of need to read through these documents, figure out what the state said, and then how is that money going to get dispersed? Some of this will be in the legislative process. Some of it will be the regulators doing it and there are sometimes like requests for proposals, RFPs that come out.
But yeah, pitching yourself to the health plans or the K 12 schools or whoever's kind of gonna be receiving that money. Or it could be the hospital. Some of 'em are gonna give it to the rural hospitals
Well, okay, so like one of the other things that I think is really interesting too, is. In the like health tech space, everything is like super innovative, right? Where the [00:33:00] new thing, where the cool thing, where the sexy, the UI is great.
And I know I struggled on this working on, a project with the state at a tech company, whereas like this, they don't want anything sexy. Like, I don't know what the hell you guys are building. They don't want, like, this is like way too forward thinking. they don't have software.
They don't have these tools. this industry is looking for things that is solving real problems, not pushing boundaries, not making things cooler, making things easier. And so it's this interesting thing of like, mm-hmm that's the language that they want. You're solving a real problem, not a make believe problem that you think is a problem because this could be a billion dollar industry in five years or whatever the hell like all these startup founders say to themselves.
But it's really Like in the Medicaid world, there is no app, right? Everything is, you pick a doctor, you go to this one webpage, random, no app, right? They mail you everything in paper. There's no notification center. Create something that actually drives access by [00:34:00] clearing some of those gaps, right?
An app that Medicaid people could use to pick a doctor and book an appointment and have a digital ID card. Ugh, that's a million dollar idea that states don't have today. So to me, I'm always like, it's not about pushing boundaries, it's about actually doing the right thing that so many people have looked over because they think it's not sexy enough, and I think that's where your listeners probably come up with their ideas in the first place of, I work in the field and there isn't something like this and there's a need for this. Because again, there's this dichotomy of if you're trying to go out and get VC funding, you need to, you know, say that you're gonna change the world and we're gonna transform healthcare.
But then there's also this trend of, startups becoming public benefit corporations. 'cause it looks a lot better. You're not a nonprofit, but you're also not this VC. Back states don't like that. A lot of states have looked [00:35:00] at procurement requirements that only nonprofits get the award or only if a for-profit corporation partners with a local nonprofit corporation because again, these are taxpayer dollars, right?
So you can't just be like, I want a 60% Markup, you know, on our software, right? Which may be the norm and maybe what your investors are expecting, but there's transparency at the state level of what's in your contract and what you're providing and how much things cost, and we all pay for it. So again, when you're dealing with Medicare or Medicaid population, these are vulnerable populations.
It's a lot of in-person care and in-person relationships and trust. so like community health workers are a really big topic in the Medicaid space right now because it's like a one-on-one relationship. People with lived experience, people who look like me, come from my neighborhood, have the same background that I do.
[00:36:00] They're gonna convince me to engage in my healthcare, not like a fancy app that I saw advertised on tv. So if you can, crack that code. And make money off of it, then you're golden. But it's just, these are really there. and that's why there's so much PE investment in these spaces.
Like, you know, wound care programs of all inclusive care for the elderly. I mean anything. There's obviously PE investment and you know, er doctors, anesthesiologists, all those, you know, but the Medicare and Medicaid space in particular, there's so many different programs. There's so many different funding sources.
Mm-hmm. But the needs are real. Those are complex populations. So I think that's why there's room so much for niche. If you just kind of focus in this one area, but it's a high cost, then you don't have to be everything to everyone. I used to joke that, we needed somebody to do like an organ transplant app.[00:37:00]
Because I led the policy there and it was literally, an organ would become available and they would call and somebody would miss the phone call and it would be this weird email phone call thing. And I'm like, how is this not streamlined across the hospital systems that do organ transplants in these states?
I mean, to me that's what I'm saying. there's so much room for these very niche ideas for somebody just to solve 'em. this is a super interesting conversation. definitely kind of reworked my wiring a bit on how approach the thinking how to kind of establish yourself and really sell yourself right.
I'm curious like what would your listeners wanna hear about? And what problems do they come to you with? Yeah, well that was one of 'em. big one is, you know, it's just really a lot of my questions were pretty selfish because I'm currently involved in these questions, per se, is how do you sell yourself as, a benefit to an insurance company, to payers, right?
Or also, you know, thinking about these [00:38:00] private, the B2B kind of things, you know? Yeah. That's always there, but it was never really thought about, hey, you know, kind of the niche applications, like a heart monitor for the flight attendants or, you know, how can this relate to a pediatric practice or how can this relate to a population health practice?
And again, the way a lot of people were thinking about it was, we have this product. Our product we think is awesome. You need it because we've built this and I think it's awesome. But really, again, it's speaking that language. the clientele the clients, the people that we're pitching it to don't need what we think we need.
They need this. Trying to get to the bottom of that question, really just reframing how you set your focus, How you set your, business, you have great business ideas, but how are you gonna convince them that this is what, basically fit their need.
it's just a different rework of how to approach the problem. I sunshine. that's why the state requires pilots. they're not gonna take your word [00:39:00] for it.
They're gonna go, I mean, sunshine was a, you know, executive at probably one of the top five health, payers in the nation. you know, you can't approach a health plan and not have data and not show, like, they're not gonna go like, Hey, like I have this really good idea. You know, like it's you go to them and you have to almost prove the concept and provide a ton of data showing that it can be successful.
Yeah. it's a good point. I wouldn't call myself an executive at those health plans, but here's something that the health companies might not know. You don't need to get a meeting with the CEO.
You need to go, who's the chief Medical officer for their Louisiana based Medicaid plan? Who's the, population health director for their Kansas foster care carve out population. Right. You're not gonna get a meeting with the CEO of Anthem. Right. But like I said, they're [00:40:00] 50 different health plans and even within that state, there are four different licenses and they have different p and ls with you know, market heads, chief medical officers, population health directors, and they are accountable for specific things in that market, in that state.
So that actually is really key of like, who do I target? Right? I don't know a lot about, the commercial, self-insured employer space, and that's all about brokers. People are always looking for how to get in with brokers and advice on how to pitch to brokers and who do you know?
I don't know a lot of brokers. I know a couple just from friends. But yeah, that's who your target audience is. The people who are accountable for the p and l in that state. 'cause every Medicaid plan is different. and here's the other thing, it's not just a pilot in that state.
when they're pitching to a state, that's a de novo market for them, a health plan. They're gonna use data from their five other Medicaid plans in their other states to [00:41:00] say, we did it in this state, we can do it for you. So if you're partnered with them in one state and the pilot's going well, they'll want to write to it in a bunch of other states.
And like Phoebe said, sometimes they don't even really have tangible results yet. The pilot started eight weeks ago, but they're gonna say, the pilot's going great. And they're gonna say, you know, so that's the other thing. Same with Medicare Advantage, right? and same with state legislation. States copy other states.
States are the incubators of democracies. Yeah. Again, check my wording on these phrases. I can never remember my idiots, but, so if you're talking to a policymaker in a state and you're able to get it, like, don't go after California, it's impossible. Take you five years, you'll fail every time. You'll spend a bunch of money on lobbyists.
But Go to Utah, love Utah. It's a 45 day legislative session. They have no staff. They'll get an intern on break from college that they share with another legislator and most of 'em have a full-time job. 'cause you can't go be a legislator [00:42:00] for 45 days if you don't have a way to pay all your bills.
Right? It's basically a volunteer position. go to those things and I mean, you know, I used to do the conference circuit and JP Morgan Chase is going on right now in San Francisco. It's a massive conference. It's super expensive to attend. If you're a health startup going and trying to get funding, go to the little conferences, go to National Conference of State legislatures.
national Association of State Health Policy. Those are the dorkiest people ever. But they're the regulators. Favorite conferences though. These are my favorite. I have a blast. don't go to the big pharmaceutical conference. Don't go to Salesforce. I mean, go to them. Yes, if you can afford to. But one time, I think during COVID, we were trying to go to the American Public Health Laboratory Association conference, the national and state Territorial Health Directors conference.
You know, get in with the people who are actually doing the [00:43:00] work and get them to know your name and know your product and figure out what they need. Ask them or just look up publicly available information. I know a super helpful kind of approach 'cause there's a lot of people that are just like, I don't know where to start.
Yeah. Because the interesting thing too is like, you have to understand the states all get together weekly from a regulator stand. So like. This whole idea of health tech of like, that's my IP and that's my thing. Like states don't operate like that. So one good idea is like, you know, new Jersey's, like I gotta talk to California.
'cause California cracked the code. And then California's doing a webinar with Maine and Wisconsin and we're sharing ideas. So you actually do something cool in a state like Utah, which now makes so much sense sunshine. How Utah has that pilot program with the AI doctor or the AI bot doing prescribing makes sense now.
But if it's a success, again, the states talk and they actually share these ideas and they share legislation and that's kind of how [00:44:00] sometimes you're able to, get something a little bit more globally by starting small. Yeah, so not just their legislatures, but also they have a much smaller Medicaid agency.
The Medicaid director is really easy to get in touch with. It's not like the Medicaid director in New York or California. You're not gonna get a meeting with that person. Or you have to hire a big, fancy lobbyist. You know? I mean, you could hire big, fancy lobbyists and you know, pay me a bunch of consulting money.
Leo thank you so much for having me. Fun. No, this is fun. This is fun. I do have a personal question for you too.
Yes. I have a friend who is a pediatric ER physician's assistant. Mm-hmm. She's been doing it for over a decade. She commutes from Madison to Milwaukee, and she has from time to time, expressed interest in like changing jobs. Right? She commutes to Milwaukee all the time, and I'm like, why don't you go get like a telehealth job?
Like you just work from home. she'll cry, right? Because she misses so much stuff with her kids, or we're trying to do book club or bunko, and I'm like, why don't you go get a telehealth job? You know, why don't you get a [00:45:00] job with a health plan or whatever? And what I naively, you know, didn't know is they always want MDs and RNs,
And I was like, asking her, you know, what's the difference between a PA and everything? And I was like, is there like a gap here? Like, are you just kind of screwed if you're a pa? Kind of. Do you want me to take this one, Leo? Yes. And it's not the practice gap.
But it's how the PA set themselves up versus how the set themselves up. And they don't lobby for independents. it's a scope thing. So has to do with lobbying and unions. doctors and physician assistants are overseen by the same regulatory board the medical board.
So doctors are in charge of the pa and they dictate what the PAs do. And then all the nurse practitioners have all lobbied to practice independently. So now there's this like tension. 'cause again, like physicians are very weird, where they're like, we think nps are taking our jobs.
We think PAs are taking our jobs. So it's this [00:46:00] interesting kind of dichotomy. the doctors are gonna block the PAs if they can. But I think the PAs are opening up and the doctors are realizing some PAs prescribe. They can prescribe. they could practice. And don't PAs run all of the urgent care clinics.
Yeah. They have like a thing up on the wall. Technically they could do so in telehealth, they just can't. the regulatory processes are a lot harder to do. it's opening up for the PAs. So drop her my line.
'Cause I'm big in the pediatric kind of telehealth thing. If she really wants. I'll recommend it to her. She's kind of one of those person who expresses interest, but I think she's just kind of stuck, in her ways because we've all, suggested things.
a friend of mine's, even introduced her to a recruiter at the in Wisconsin, UW health system. SoI can say it to her, but I was also just curious for my own, 'cause I was looking up jobs right.
They claim there's more risk with overseeing a pa. it goes back to this whole inadvertent fear that physicians have about assuming risk if you had a client that was doing a telehealth company and it's all run by [00:47:00] PAs, they would wanna get a bunch of funding so they could hire a bunch of lobby.
I mean, again, they would not win, but they could try a pilot prove. It was like, when midwives wanted to do like IUD insertions, whatever let us do a pilot, prove that it's safe. Nobody died. well, you're gonna have to convince the medical board run by physicians to credential your PAs to do that.
So need regulatory lobbyists. So yeah, you'd have to convince the medical board to do that. Interesting. So with the nurse practi board, That's the tension. the nursing union has just, they lobbied, There's this weird tension between nps and PAs also.
'cause like all my clients are PAs. what are they doing? I thought all your clients were doctors. so it's a mixture. Most of my clients fall in the PA side. Or a mixture of like a doctor with an NP or a doctor with a field, and are they doing telehealth?
They're either building their own platforms. oh, and does your service provide the chief medical officer for them to practice under Sometimes. I mean, sometimes connect them with, Leo, right.
Short [00:48:00] answer is, yeah, we can do that. So, I'm very friendly in terms of that. I thought most of your clients were doctors doing their own time. No, it's a mix. I have some doctors, but it's a mixture. I like helping PAs because to your point the only companies that do it for PAs charge an arm and a leg like 10 grand to get set up.
And I'm like, that's such a racket. 'cause PAs are so independent, they honestly just need somebody to teach them. And so I literally just. Teach them how to do it and spend very minimal time
Yeah. So, hey, we're wrapping up. this is an awesome conversation. God, there's so many corollaries that, we go through. And honestly, a lot of my questions, like I was saying before, were very selfish because it's questions that I have personally going through my business or businesses.
But thank you so much for all this information. This is. Super eye-opening. thank you. Now, closing question. Kind of what we ask everybody is, hey, you know, going back to yourself, let's say, you know, day one outta college, just had your diploma and you go, sunshine, [00:49:00] let me impart this one piece of knowledge to you.
You go back in a time machine, find yourself and go, listen, this is what I need you to know, and your life's gonna be so much better from now on. What would it be? Oh, goodness. It's not really healthcare. No, it doesn't gotta be. it would be to say yes to things. I think most of the regrets in my life, this is probably a common thing for people, are not the things I did, but the things I didn't do.
Oh, that's a good one. yeah. Yeah, a couple things where if I have daughters or nieces, then I would say, don't rearrange your life for a man. You know, if you get a job offer that's in another state, go for it. A college scholarship that's in another state, go for it.
Don't plan your career or your life around, you know, a man. Yeah. My daughter's gonna be listening to that one, but, yeah. okay. Let's go back. Advice. [00:50:00] Take more risks. Definitely from my perspective, take more risks. Say yes to more things. Try things. Most of my internships were okay. Checked.
Crossed that off the list, figured it out. I didn't wanna do that. Didn't like it. So it's amazing. Thank you so much for taking your time. This was a super enjoyable conversation. Again, super educational on my end. Thank you so much for having me. And then Sunshine. If people wanna get in touch with you, what's the best way for them to reach out?
Sunshine. More consulting@gmail.com. It's very clever and very hard to remember. Sunshine more consulting. You know, LinkedIn's a great way to reach out to me. Sunshine. More anger on LinkedIn. Yes. Sunshine. Like the word more. M-O-O-R-E. Anger, like the word on LinkedIn. Amazing. Thank you so much for your time.
This was incredible. Thank you. I really appreciate it. Thank y'all. See you all next time.