Out-of-pocket payment deters telemental healthcare use

Recent research shows that requiring patients to pay out of pocket for telehealth visits is linked to substantially fewer telemental health visits.

Published in JAMA Network Open, the study assessed the effect of a regulatory exemption on telehealth utilization among patients seeking mental healthcare. The exemption allowed people with high deductible health plans (HDHPs) to have telehealth visits without paying a deductible. The exemption is slated to expire at the end of 2024.

Researchers from Harvard Medical School, telehealth provider Included Health, the University of Michigan, and Beth Israel Deaconess Medical Center set out to examine telemental healthcare utilization changes linked to the reintroduction of cost sharing.

The study included data for patients receiving telemental healthcare services from Included Health, covered under two clients: an employer and a health plan. Researchers analyzed the data for two phases: a pre-intervention phase between January 1 and June 30, 2021, where patients did not have cost-sharing for telehealth visits, and the intervention period from July 1 to December 31, 2021, where one client, either the employer or health plan, reintroduced cost-sharing while the other didn’t. The group for whom cost sharing was reintroduced was dubbed the intervention group, while the other was the control group.

The study included 15,024 patients, 6,940 of whom were in the intervention group and 8,084 of whom were in the control group. The intervention group was more likely to live in urban areas (95.1 percent) than the control group (79 percent).

During the pre-intervention period, the intervention group had a mean of 4.8 telemental health visits per patient, and the control group had a mean of 4.7. In the post-intervention period, the mean out-of-pocket costs per visit were $29.50 for the intervention group and $0 for the control group.

However, researchers observed that the mean number of visits per patient per month was lower in the intervention group than in the control group during the post-intervention period. Adjusted models revealed that cost sharing was associated with 1.5 fewer visits per patient and an 11.7 percent reduction in the proportion of patients who had any visits post-intervention.

“These findings imply that the expiration of the predeductible telehealth coverage exception in January 2025 may reduce mental health service use, which could lead to worse clinical outcomes,” the researchers concluded.

Telemental health service availability has declined following the expiration of the COVID-19 public health emergency. A study published last week revealed that only 79 percent of mental health treatment facilities offered telehealth after May 2023 compared to 81 percent before.

The study involved researchers contacting 1,404 mental health treatment facilities in two waves, with the first wave lasting from December 2022 to March 2023 and the second wave from September to November 2023.

The researchers found that in addition to the decline in overall telehealth availability, the availability of audio-only telehealth declined from 49.3 percent to 34.1 percent, and the availability of telehealth for comorbid mental health and alcohol use disorder (AUD) declined from 76.3 percent to 66.5 percent between the waves.

These decreases are concerning because telemental healthcare remains widely popular nationwide.

FAIR Health data shows that mental health conditions were the top conditions diagnosed via telehealth in April 2024, encompassing 68.9 percent of telehealth claim lines nationally.

Additionally, mental health conditions remained the top-ranking diagnostic category nationally and in every region from March to April 2024. Generalized anxiety disorder and major depressive disorder were the top mental health diagnoses in April, accounting for 34.7 percent and 21.6 percent of telemental health claim lines, respectively.