Telemental Healthcare Grew Ten-Fold During Pandemic, Remains 'Elevated'

Telemental healthcare utilization, which skyrocketed during the COVID-19 pandemic, remains "persistent and elevated," according to new research.

The research letter published in JAMA Health Forum detailed an assessment of monthly telehealth and in-person utilization and spending for mental health services among commercially insured US adults between 2019 and 2022.

Researchers from RAND Corporation, Castlight Health, and Brown University School of Public Health conducted the assessment. They aimed to examine trends in mental healthcare utilization and spending before the public health emergency (PHE) declaration expired in May.

The researchers examined mental healthcare utilization and spending in three periods:

• Before the PHE declaration — January 1, 2019, to March 12, 2020
• During the acute phase of the pandemic before vaccines became available — March 13, 2020, to December 17, 2020
• During the post-acute phase of the pandemic — December 18, 2020, to August 31, 2022

They assessed the number of monthly medical claims per 1,000 beneficiaries and spending per 10,000 beneficiaries among around 7 million commercially insured adults. They gathered claims data from self-insured employers offering Castlight Health as a health benefit. The data covered anxiety disorders, major depressive disorder, bipolar disorder, schizophrenia, and post-traumatic stress disorder.

The research team included 1.55 million mental health service claims in the study.

The study shows that in-person visits decreased by 39.5 percent, and telehealth visits increased roughly ten-fold by 1,019.3 percent during the acute phase compared with the year prior. When taken together, this represents a 22.3 percent increase in overall utilization of mental health services. Researchers also found that these trends were mostly consistent across different mental health conditions.   

During the post-acute phase of the pandemic, telehealth visits stabilized at 1,068.3 percent of pre-pandemic levels, which is approximately ten times as high as before the pandemic. Meanwhile, in-person visits for mental healthcare increased by 2.2 percent per month during the post-acute phase.

Overall, mental health service utilization was 38.8 percent higher than before the pandemic by August 2022.

During the acute phase of the pandemic, per capita expenditures for mental healthcare were 29.5 percent higher compared with the previous year. During the post-acute phase, spending for telemental health services remained stable, but spending for in-person care dropped to pre-pandemic levels.

"These findings suggest that telehealth utilization for mental health services remains persistent and elevated," the researchers concluded. But they also warned that "if this increased utilization affects spending, insurers may begin rejecting the new status quo."

These concerns are further heightened because telehealth flexibilities supporting access to mental healthcare may not be made permanent.

For now, certain telehealth flexibilities for Medicare beneficiaries remain in place, including a waiver lifting the initial in-person care requirements for those receiving mental healthcare through telehealth. However, these waivers have only been extended through December 31, 2024.

But, lawmakers appear to favor making mental health-related telehealth flexibilities permanent.

In May, Congresswoman Doris Matsui (D-CA) and Congressman Bill Johnson (R-OH) reintroduced the Telemental Health Care Access Act to support access to telemental health services by eliminating barriers for Medicare beneficiaries.

The bill would remove the requirement that Medicare beneficiaries see doctors in person within six months of virtual treatment for mental concerns.

Additionally, last May, four US Senators released a discussion draft of telehealth policies for mental healthcare initiatives that focus on increasing access and directing insurers to support virtual care.

As efforts to expand access to telemental healthcare gain steam, stakeholders must be wary of the healthcare disparities impacting telehealth use.

A study published earlier this year showed that while the share of mental health facilities that used telehealth grew from 39 percent in April 2019 to 88 percent in September 2022, counties with a Black population exceeding 20 percent of the total population had a 42 percent lower chance of using telehealth.