Telemental Health Grew After Onset of COVID-19, But Varies Across US

A recent study published in the American Journal of Managed Care (AJMC) found that although the onset of the COVID-19 pandemic led to a large increase in the odds of telehealth provision in mental healthcare facilities, various organizational and state-level factors have affected its implementation. 

Although telehealth was being used prior to the COVID-19 pandemic, in-person restrictions that began during this period led to a sharp increase in its use, particularly among those in need of mental healthcare. In January 2022, the FAIR Health Monthly Telehealth Regional tracker indicated that mental health conditions were the No. 1 telehealth diagnosis for the third month in a row.

Given the high level of telehealth use in treating mental health conditions, researchers aimed to determine how various organizational and state characteristics affected telemental healthcare practices, along with how they compared to pre-COVID-19 standards.

To do this, researchers used the 2019 to 2020 Substance Abuse and Mental Health Services Administration’s National Mental Health Services Survey data. The organizational characteristics that the study included were facility type, accepted payment, geography, and language service provisions. Researchers also considered various state-level factors, such as payment parity laws, shelter-in-place laws, and COVID-19 cases.

The study sample included 24,581 facilities, 63 percent of which were outpatient facilities, 13 -14 percent inpatient facilities, and 12 percent residential treatment centers. Also, 61 percent were private nonprofit organizations.

Regarding geography, 24 percent were in the West, 22 percent in the Northeast, 25 percent in the Midwest, and 29-30 percent in the South.

The study also notes that 88 percent of facilities accepted Medicaid, and 68 percent accepted Medicare. Between 57 and 58 percent of facilities offered American Sign Language (ASL), and 73 to 75 percent offered services in at least one language other than English.

Between 2019 and 2020, the share of organizations that offered telehealth rose from 38.2 percent to 69 percent. Further, the odds of facilities offering telehealth multiplied four-fold within this timeframe.

Between 2019 and 2020, the types of organizations that became more likely to offer telehealth were Veterans Affairs (VA) medical centers and community mental health centers (CMHCs), along with private for-profit organizations. Facilities that accepted Medicaid or Medicare also had a higher chance of offering telehealth following the pandemic's onset than those that did not. Conversely, inpatient settings, private nonprofit organizations, and public agencies had a lower chance of offering telehealth after the pandemic began.

Geographically, facilities in states in the West and South had a higher chance of offering telehealth compared to those in the Northeast and Midwest states. Also, facilities in states with payment parity laws were more likely to provide telehealth than those in states without.

Finally, facilities in states with an American Telemedicine Association (ATA) performance grade of A or B and facilities that offered ASL or a non-English language had a higher chance of offering telehealth.

Although it was apparent that telehealth use within mental health organizations grew following the COVID-19 pandemic, variations in availability based on state and organizational characteristics suggest disparities, researchers concluded. Certain actions, such as expanding payment parity, could help ensure equitable delivery.

As telehealth use increased, disparities in access have become more visible.

A study from March showed that telehealth use for primary and integrated mental health visits was not similar between rural and urban VA beneficiaries, highlighting the digital divide.

However, researchers noted that the coordinated telehealth response of the VA healthcare system could benefit from managing rural disparities associated with structural capacities, such as internet bandwidth. They also stated that rural adoption of telehealth could benefit from the technology customization.