Telehealth's first act was a pandemic scramble: the video visit as a temporary stand-in for the waiting room. Useful, but it was training wheels. The second act, the one that actually lasts, looks less like a video call and more like care that comes to you: asynchronous, at home, on your schedule.
The video visit was the training wheels
A video appointment just moved the old model onto a screen; same fifteen-minute slot, same wait for a booking, same reliance on the patient organizing everything. It proved remote care was possible without changing what care *is*. The durable version does change it, messaging-based follow-ups, home sample collection, medicine to your door, monitoring that doesn't require a scheduled call at all.
I built the second act before it had a name
When COVID hit and no service existed, we built 6-hour traveler testing at Praava from scratch, plus home-based collection, care that traveled to the patient instead of the reverse. Access-scarce markets were forced into the at-home, asynchronous model years before richer ones chose it, because there was never enough clinic capacity to insist people come in. That constraint produced exactly the shape the US is now drifting toward.
Reimbursement is the wildcard, not the foundation
US telehealth flexibilities have been extended through 20271, which keeps the lights on, but building your model on a reimbursement rule is building on sand. The durable winners won't be the ones a policy happens to pay for; they'll be the ones patients actively prefer because the care genuinely comes to them. When the rule eventually changes, preference is what survives.
What this means for builders
Stop porting the clinic visit onto video and start removing the visit. Ask what can be async, what can happen at home, what can be delivered rather than attended. The second act of telehealth isn't a better waiting room, it's the quiet disappearance of the waiting room, and the markets that never had good waiting rooms are the ones showing everyone else how.
The short version
- The video visit was training wheels, remote care without changing what care is.
- The durable model is async, at-home, delivered, the waiting room quietly disappears.
- I built it early at Praava: 6-hour testing and home collection, care that came to the patient.
- Don't build on a reimbursement rule (extended to 2027); build on care patients actively prefer.
If you removed the scheduled visit entirely, how much of the care you deliver could simply come to the patient instead?
Frequently asked questions
What is telehealth's "second act"?
The first act was pandemic video visits, essentially the old waiting-room model moved onto a screen. The second act is asynchronous, at-home care: messaging-based follow-ups, home sample collection, medicine delivered to your door, and monitoring that doesn't need a scheduled call at all.
How did emerging markets get to this model before the US?
Access-scarce markets were forced into async, at-home care years before richer ones chose it, because there was never enough clinic capacity to insist people come in. At Praava I built 6-hour traveler testing and home-based sample collection during COVID, care that traveled to the patient, which is the shape US telehealth is now drifting toward.
Should telehealth companies build their model around reimbursement rules?
No. US telehealth flexibilities have been extended through 2027, but building a model on a reimbursement rule is building on sand. The durable winners will be the ones patients actively prefer because the care genuinely comes to them, since preference survives when the rule eventually changes.
Sources
- U.S. Senate (Senator Cindy Hyde-Smith press release) / KFF analysis. hydesmith.senate.gov ↗
Md Shafaat Ali Choyon (MPH, CHES®, MBA, MCIM) is a growth, marketing and public-health strategist who builds and runs AI in production, with 17 years across telecom, fintech, e-commerce, consumer tech and healthcare in the US and Bangladesh. See the essays or the portfolio.