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: Health Plans Buy Outcomes, Not Ideas No matter how innovative a product is, payers care about measurable impact—cost reduction, quality improvement, and expanded access. If it doesn’t align with how states and plans are evaluated, it won’t get traction.Medicaid and Medicare Require a Different Playbook Public payer populations are often hard to reach, less tech-enabled, and account for the majority of healthcare costs. Successful solutions must be population-focused, not consumer-focused.Start Small, Prove Value, Then Scale States copy each other. Health plans replicate pilots across markets. Winning in a smaller, more accessible state or niche population can unlock broader adoption nationwide.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: Dr. Leo Damasco – Pediatrician and emergency medicine doctor turned telemedicine advocate, helping physicians transition to digital health.Phoebe Gutierrez – Former state regulator turned telehealth executive, specializing in compliance and sustainable virtual care models. Connect with Phoebe Gutierrez: https://www.linkedIn.com/in/pkgutierrez/ phoebe@telemedicinetalks.com (mailto:phoebe@telemedicinetalks.com)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 The information provided in Telemedicine Talks is for educational and informational purposes only and should not be construed as medical, legal, or financial advice. While we discuss best practices, industry trends, and real-world experiences, every situation is unique. Listeners should consult with qualified professionals before making decisions related to telemedicine practice, compliance, contracts, or business operations. The views expressed by the hosts and guests are their own and do not necessarily reflect those of any organizations they may be affiliated with. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
