Expert Opinion
Craig Settles: The Role of Telehealth in States’ Broadband Plans
Communities need a strong human element for telehealth to succeed, so digital navigators are key to the team.

Telehealth visits were estimated to account for fewer than 1 percent of all outpatient visits before 2020. Then COVID hit. Telehealth use was off the chain!
U.S. Census Bureau Household Pulse Survey data revealed 22% of the U.S. population used telehealth services in 2022. As the 60s ad said, “You’ve come a long way, baby!” Much of the general public is now familiar with the basic virtual doctor visit.
But are state and local broadband teams on board with using telehealth to drive broadband adoption? Here are three pilot programs that address urban social determinants of health (Chattanooga Tenn.), family mental health delivery (Kansas City, Missouri), and a developing digital equity ecosystem that includes telehealth (Torrington, Wyomin). These pilots offer valuable lessons in driving ACP enrollments.
Much of digital health requires broadband infrastructure and computing devices. “When one looks at healthcare and technologies in the App Store today, there are over 400,000 healthcare-related apps, not to mention content items available on the Web” said Equiva CEO and Co-Founder Nir Altman.
Accepting that telehealth is one logical path to broadband adoption, pilot projects are one method for verify the impact on broadband adoption.
Chattanooga pushes the envelope – again
Chattanooga and their urban broadband network are a booming success story, and they are moving to the next level by distributing 1,000 free telehealth accounts in a pilot to impact the social determinants of health one of most economically blighted area in the city.
“Our pilot project is bringing a variety of resources to a beautiful but under-resourced neighborhood called Orchard Knob,” said Deb Socia, president and CEO of the Enterprise Center, a nonprofit that works at the intersection of technology and inequality. “The neighborhood has high levels of diabetes, stroke, heart disease, asthma. We’re providing home Internet access, digital skills training, and devices.” Some homes are getting energy upgrades and smart thermostats.”
Many Orchard Knob residents work but not at jobs that offer medical insurance, and they earn too much to qualify for the state’s health programs. It will be difficult for residents to mitigate the negative effects of the without telehealth.
The city-owned electric power board, EPB, is critical to success. EPB was part of planning from the beginning, they contributed funding, they will power the telehealth accounts, and EPB is building out free WiFi in public spaces.
The Enterprise Center received a Tennessee Valley Authority award, and their healthcare partner is the Parkridge Medical System.
Eight steps to the pilot
Essential Families is a 501(c)3 nonprofit that conducted a telehealth pilot in one of the poorest communities in Kansas City, MO with stellar results. They delivered mental healthcare for families and also virtual parent education that enhanced parenting skills.
Their pilot has eight steps, starting with:
Step 1. Developing a database of residents who could potentially use telehealth and broadband. 69 homes participated in the pilot.
Steps 2 and 3. Their Chief of Digital Marketing, Kenneth Yancy, said, “We had to go directly to the people to educate them about FCC’s Affordable Connectivity Program (ACP). Our partners such as the school district and childcare providers were part of the needs analysis process.”
Step 4 When residents registered for the pilot and completed their forms, Essential Families gave them free laptops. The incentive motivated residents to provide data that is difficult for government agencies to collect.
Step 5. Each participant was assigned a digital navigator who walked the family through the processes leading to telehealth services, including enrolling with ACP and training for the video streaming platform, computer, and Internet.
Step 6. A minimum of 15 virtual parental education sessions and six mental healthcare services.
Step 7. An extensive follow up by the additional navigator.
Step 8 The pilot evaluation report that is helped significantly by the electronic and manual tools that execute various real-time assessments, impacts, and cost/benefits analysis.
Rural telehealth
Wireless ISP Vistabeam launched their first Empowerment Center in Torrington, Wyoming. The Center offers ACP enrollment help, digital skills training, video conferencing, and Microsoft delivers digital skill programs.

Matt Larson, owner of Vistabeam
“A fulltime digital navigator is on-site, and we are working with a telehealth company to pilot a home test suite that includes an oximeter, blood pressure monitor, and blood testing,” says Matt Larson, owner of Vistabeam. “The device will be part of the Center’s telehealth capabilities, along with remote doctor visits.”
Rural communities need a strong human element for telehealth to succeed, so digital navigators are key elements of the team. The Center draws people in by emphasizing familiarity, knowledge, no pressure, and exploration.
Larson believes digital equity is just one component of a giant ecosystem of social services to help take care of people. However, there can be a lack of coordination between many of these resources. Effectively coordinating these resources is the way to get maximum collective impact from the ecosystem. The Center staff connects people with complementary social services and other resources.
The quality of broadband infrastructure is key to telehealth success – it cannot fail customers! “The soul of a broadband deployment is in that relationship between an ISP and the customer,” says Larson.
Piloting innovation
Communities need to understand that telehealth is not connections just between doctors and patients. “It’s not up to the patient alone, but also loved ones and care providers in a collaboration that occurs in the care process,” said Altman. “There are many supports groups such as the Cancer Support Community that supports hundreds of thousands of patients and loved ones.”
The broadband infrastructure supporting telehealth should pilot test these many-to-many connections and resources to be sure they are supported. Pilots should include tools that enables patients, urban and rural activists, and communities to do their own healthcare needs assessment as well.
Jason Welch, Infiniti Mobile president said, “By expanding the ecosystem beyond broadband and telehealth providers to include healthcare organizations themselves, there’s a unique opportunity to educate the patient. ‘Here’s your device and software, and here’s how you maximize the value of their use.’”
If a city’s telehealth pilot is driven by the creation orientation, a community builds or invents things that didn’t exist before. With the creation orientation, you reduce tunnel vision because you’re always pushing the envelope of innovation.
Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.
Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.
Expert Opinion
Johnny Kampis: Broadband Industry Hopeful to Get Waivers from Biden Administration Protectionist Policies
The Buy America mandate could seriously hamper the Broadband Equity, Access and Deployment program.

In a presidential administration rife with protectionist policies, the broadband internet industry is optimistic it will receive waivers from the “Buy America” mandate that threatens to derail plans to close the digital divide.
The National Telecommunications and Information Administration is likely to announce state funding allocations for the $42.5 billion Broadband Equity, Access and Deployment program by the end of June. That is the biggest piece of the taxpayer-funded pie allocated by Congress to extend broadband infrastructure across the U.S. over the next several years.
But, as the Taxpayers Protection Alliance has reported, broadband industry leaders say the Buy America mandate could seriously hamper the effort. As part of the mandate, the Biden administration has said that at least 55 percent of the component parts of a product used in federal construction projects must be sourced domestically. That rule applies to any infrastructure project, but broadband has taken center stage recently with the BEAD funding imminent.
Because fiber-optic cables primarily used in broadband infrastructure projects include materials such as aluminum, copper, glass, plastic and steel that are primarily manufactured in other countries, under the current rules they would be forbidden. And many other important cogs in the broadband machine, such as routers and switches, are mostly made overseas. Even the left-leaning Brookings Institution noted the policy “could put broadband deployments as risk.”
Fortunately, the Biden administration is softening on its Buy America policies — at least in the broadband industry. NTIA chose earlier this month to exempt several categories of equipment such as broadband routing equipment, transceivers and antennas from the domestic manufacturing requirements in the Enabling Middle Mile Infrastructure Program. The agency said that “although there are public and private efforts underway to increase manufacturing capacity… industry will not be able to address shortages of the manufactured products and construction materials required for middle mile network deployment within the timeframes required.”
Broadband Breakfast pointed out in a recent article that it will take several years to ramp up production of semiconductors in the U.S. and the BEAD program has set a five-year timeline for project completion.
“The estimates are that it would take at least, at a minimum, three to five years to bring a semiconductor chip plant to the U.S.,” said Pam Arluk, vice president of NCTA – The Internet & Television Association. “And even though the BEAD program is going to be over several years, that’s still just not enough time.”
The inherent difficulties in meeting the Buy America mandate, and the precedent now set with the middle mile program, provide optimism that waivers will likely be offered with BEAD. But that is just one of many infrastructure programs now being funded by taxpayers through federal recovery programs.
As President Joe Biden said in his State of the Union Address in February, “American-made lumber, glass, drywall, fiber optic cables…on my watch, American roads, American bridges, and American highways will be made with American products.”
Washington Post columnist Fareed Zakaria pointed out that what he calls the “Biden Doctrine” violates the spirit of the World Trade Organization and its framework of open trade. And another Post columnist, former Clinton administration Treasury Secretary Lawrence Summers, noted that protectionist policies tend to hurt more people than they help — giving as an example steel tariffs that aided 60,000 steel workers, but threatened the jobs of 6 million other workers in industries paying inflated prices for steel.
Strides in broadband waivers are a good sign, but the Biden administration must do more to curtail its protectionist policies as industries use economic recovery funds to build infrastructure in the coming years.
Johnny Kampis is director of telecom policy for the Taxpayers Protection Alliance. This piece is exclusive to Broadband Breakfast.
Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.
Expert Opinion
Angie Kronenberg: The FCC Must Act Now to Save the USF
While the USF remains vital in an ever-increasing connected world, it is in serious jeopardy of surviving.

Last week, the Senate Subcommittee on Communications, Media and Broadband held a hearing titled “The State of Universal Service.” The Universal Service Fund is our nation’s critical connectivity program that helps ensure that voice and broadband services are available and affordable throughout the country.
Since its creation by Congress in the 1996 Telecom Act, the USF has become a program that millions of families, community anchor institutions and small businesses rely on to get connected. It has been especially valuable for families and businesses that rely on it for work, school and telehealth at home.
The USF spends about $8.5 billion annually to help fund affordable connectivity in rural areas, low-income households, schools, libraries and rural hospitals. Today, the Federal Communications Commission is working to make high-speed broadband as ubiquitous as telephone service, and broadband is the essential communications technology the USF now supports.
While the USF remains vital in an ever-increasing connected world, it is in serious jeopardy of surviving. To fund the programs, telecom providers are required to pay a certain percentage of their interstate and international telecom revenues, known as the “contribution factor.” Typically, telecom providers collect these USF fees from their customers on their monthly bills.
However, the telecom revenues that fund the USF have declined over 60 percent in the last two decades. As a result, the contribution factor has skyrocketed from about 7 percent in 2001 to a historic high of about 30 percent today, as a higher portion of telecom revenues is needed to sustain the fund. That means certain consumers and businesses are now paying an additional 30 percent on top of their phone bills in order to fund the USF.
Telecom revenues continue to decline so rapidly because customers today rely more on broadband services and less on landline and mobile phone services, but broadband revenues do not pay into the USF. While the FCC has modernized each USF program to help support broadband service, it has not modernized its funding mechanism to require broadband services to pay into the Fund even though historically the agency has required supported services to be included in the contribution system.
Without intervention, the contribution factor is predicted to rise to 40 percent by 2025. This is unsustainable and puts the stability of the entire USF at risk. In fact, the contribution factor has become so high that it has led some groups to challenge the USF in federal court as unconstitutional, which also threatens the sustainability of the USF.
Reforming the USF funding mechanism is urgently needed and long overdue
Over 340 diverse stakeholders have come together as the USForward Coalition calling on the FCC to move forward with USF reform by expanding the contribution base to include broadband revenues. This solution is based on the recommendation in the USForward Report (that INCOMPAS helped commission), which was written by USF expert and former FCC official Carol Mattey.
The USForward Report explains that the most logical way to reform the contribution system and sustain the USF is to include broadband revenues in its funding assessment. Under this approach, the contribution factor is estimated to fall to less than 4 percent. It also means that the services that get USF support are paying into it, rather than solely relying on telecom customers, including those that have not made the switch to broadband, such as older Americans.
In fact, some members of Congress understand the urgency of reform and also want the FCC to act. The Reforming Broadband Connectivity Act, for example, is a bipartisan, bicameral bill that would require the FCC to reform the contribution system within one year.
Some question whether large tech companies should be assessed to contribute to the USF, and the short answer is “No.” Tech companies invest $120 billion each year in global internet infrastructure, and unlike broadband providers, these companies do not request or receive USF funding for these investments.
The FCC also lacks the authority to regulate tech companies and doing so would require Congress to act. This would further delay reform and expand the FCC’s regulatory authority over all online content and services — an overreach that many question as too broad since nearly every business today has an online presence and uses the internet to conduct business. Moreover, proposals to target certain tech companies risk skewing the online marketplace and competitive markets.
Some also question whether we still need the USF at all, and the short answer is “Yes.” While Congress allocated tens of billions for broadband, most of this investment is targeted for deployment, yet a significant portion of the USF programs focus on affordability. We not only have to make sure we build out our broadband networks, but also that communities can then afford to subscribe to these services.
The FCC should not wait to reform the USF. The USForward Report sets out a real plan that the FCC can and should implement. Congress should encourage the FCC to act now and save the nation’s critical connectivity program.
Angie Kronenberg is the president of INCOMPAS, where she manages the policy team and its work before federal, state and local governments, as well as leading the association’s efforts on membership and business development. This piece is exclusive to Broadband Breakfast.
Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.
Expert Opinion
Craig Settles: And a Little Child Shall Lead Them — Digitally
How many communities are leveraging their teen populations in the pursuit of broadband and digital equity?

In 2011 at the MoBroadbandNow Summit in Missouri, I listened to the CIO of the City of Springfield explain why his city included teenagers in important broadband needs assessment and planning meetings. “In your home, who do you call when you’re trying to figure out how to use the VCR?”
His point? Springfield learned a valuable lesson: Teens push the edges of technology, and understand how to use technology better than many adults do. Therefore, it is imperative to include teenagers in the planning of what is and will be their main future technologies. The brain power and the creativity alone will lead to the success of tapping this demographic.
Fast forward to 2023. How many communities are leveraging their teen populations in the pursuit of broadband and digital equity? “Kids want to get a look into the future,” said Kevin Morris in a video. “That’s the thing that drives many of them in school.” Morris talks to many students as the director of college, careers and community services for the Duarte Unified School District.
What about their future in broadband, I wondered, when a friend talked to me about her efforts to recruit internship positions for the K12 Foothill Consortium? Many of the high school students in the Consortium are anxious to intern remotely or in-person near their homes in Southern California. It hit me — take the Springfield model of teen engagement to the rest of America!
Imagine the possibilities for local broadband or digital equity teams, local government and nonprofits if they can channel bright, tech-savvy, energetic, inquisitive teens on a mission to help bring the digital equity solutions to communities. Remote or in person interns can help with focus groups, town halls logistics, preparing and writing newsletters, usability testing and Affordable Connectivity Program enrollments.
The K12 Foothill Consortium is recruiting internship hosts for the June through August period and for at least 60 hours total. Those groups and organizations engaged with broadband and digital inclusion projects get the benefit of interns’ prior training in coding, health care, web design, engineering and other related disciplines. Since interns prefer paid internships, the Consortium also raises money for organizations that may be too cash-strapped to offer a stipend but can offer meaningful internships.
Internship hosts view the relationships as a win-win for everyone involved. Ivan Ayro, director of adult and career technical education at Charter Oak Unified School District, agrees. “Students are able to connect the educational experience they’re getting from Career Technical Education classes with real-life experience from workplace learning. Through the internships, many of our students are able to realize in high school if this is something that they want to do for the rest of their lives.”
A recent US News & World Report article states that, although internships are traditionally for college students, high school students increasingly are participating in them. Benjamin Caldarelli, co-founder of Princeton College Consulting, a New Jersey-based educational consulting company, said, “High school students want to work somewhere that interests them and potentially make what they feel is a more meaningful contribution. They see internships as an enrichment activity and opportunity to make an impact rather than simply trading time for a little money.”
More than 205,000 new jobs will need to be created to complete the Broadband Equity, Access and Deployment expansion plans, many of them skilled workers. “There is a lot of focus placed on building broadband networks, but we cannot build them without a proper workforce,” Fiber Broadband Association CEO Gary Bolton said in a press release. “Failure to ensure the availability of high-skilled labor will result in workforce bottlenecks, which will ultimately lead to higher costs and project delays.”
The National Telecommunications and Information Association is requiring every state to have a five-year workforce development strategy. FBA published a guidebook to help states develop that strategy. Broadband and digital inclusion teams need to pencil in “internships” as part of their plans.
High school broadband and digital inclusion interns may not be considered skilled workers, obviously, but the interns should be considered the beginning levels of workforce development campaigns in every community. Start people thinking about broadband and all things digital in high school and use internships to shape their college or post-high school plans. Don’t forget that Gen Z can be an important part of broadband discussions, even if they’re not interns.
Amy Foell, principal of Amy Foell Consulting LLC, heads the K12 Foothill Consortium for Azusa, Charter Oak, Duarte and Monrovia Unified School Districts’ CTE. Their mission is to educate and train students to provide a community-sourced talent pool to sustain a healthy, balanced, local economy. Foell also supports workforce development programs across the San Gabriel Valley, including Pasadena Unified School District.
“I like to have an initial phone call and 15 to 20 Zoom sessions to ensure prospective internship sites understand the program,” said Foell. “Before we meet, it’s advisable to create a brief description of the internship project — be sure to share the organization’s purpose and mission. We’ll help hosts identify and interview candidates in May to early June, and students can start mid-June.”
Craig Settles conducts needs analyses, planning, and grant assessments with community stakeholders who want broadband networks and telehealth to improve economic development, healthcare, education and local government. This piece is exclusive to Broadband Breakfast.
Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.
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