I may be wrong, but I don't believe you can access the H.264 stream to send to a remote location, say for a video conference application. I believe the API only allows for saving to a file.
The Cisco paid MPEG LA license fees only cover the Cisco delivered binaries. Doesn't sound like this completely free plug-in method would work for say, iOS apps which can't download external binaries. You'd still have to cover the MPEG LA licensing.
According to http://www.openh264.org/faq.html
"In order for Cisco to be responsible for the MPEG LA licensing royalties for the module, Cisco must provide the packaging and distribution of this code in a binary module format (think of it like a plug-in, but not using the same APIs as existing plugins), in addition to several other constraints. "