Telemedicine has matured from an emergency workaround during the pandemic to a durable pillar of hybrid healthcare delivery. In late 2025, the strategic questions have shifted: under what conditions does virtual care safely substitute for in-person encounters, where does it add unique value, and how do institutions organize governance, reimbursement, and workforce strategies so that telemedicine closes—rather than widens—gaps in access and outcomes? This article develops a socio-technical, multi-theoretical analysis suitable for journal-level readers. It integrates the “quadruple aim” with Bourdieu’s forms of capital, institutional isomorphism, and world-systems theory to show how patterns of power, legitimacy, and dependency shape telemedicine at every layer—from device supply chains to bedside communication and cross-border data flows. Building on evidence and practice patterns observed across primary care, behavioral health, dermatology, and chronic disease management, the article proposes an H-SAFE operating model (Hybrid pathway design; Standards & safety; Alignment of incentives; Frontline enablement; Evaluation & equity), presents a maturity rubric for remote patient monitoring (RPM), and outlines a research and policy agenda for the next three years. The result is a critical, yet practical, roadmap for health leaders seeking safe, equitable, and economically sustainable telemedicine at scale.