Telehealth Availability at FQHCs Linked to Engagement in Mental Healthcare

A study published in JAMA Network Open found that despite an overall decline in visit rates throughout the COVID-19 pandemic, high telehealth availability led to better care engagement among Medicaid beneficiaries with mental health conditions treated within federally qualified health centers (FQHCs).

Various studies have shown telehealth has expanded and improved care for mental health patients and those with low incomes during the COVID-19 pandemic.

For example, a June report from FAIR Health noted that mental health conditions were the most common telehealth diagnoses at the national level between 2020 and 2022. 

Also, according to the new JAMA Network Open study, only 6 percent of Massachusetts FQHCs used telehealth to provide live mental health services in 2019. However, in 2020, all Massachusetts FQHCs delivered mental health services through telehealth.

Despite this growth, some uncertainties remain, mainly surrounding the correlation between telehealth availability and visit rates among mental health patients enrolled in Medicaid.

To assess the correlation, researchers conducted a cohort study that included patients between the ages of 18 and 64 who were Medicaid beneficiaries with a mental health diagnosis. All study participants were also attributed to Community Care Cooperative and had at least one FQHC visit within 18 months prior to each month studied. This included at least one visit that took place before the expansion of telehealth during the pandemic. The main source of data was the 2019-2021 Electronic Data Warehouse.

Using data from 11,267 patients, researchers found that overall visit rates in FQHCs declined during the pandemic. However, despite this decline, higher availability of telehealth was associated with higher visit rates compared to lower telehealth availability. Results were similar after reviewing data from patients with various diagnoses.

Based on this information, researchers concluded that the high availability of telehealth within FQHCs is linked to higher levels of care engagement among Medicaid beneficiaries with mental health diagnoses. 

However, the study's limitations included the use of only one year of post-telehealth expansion data, potential errors in data reporting, and uncertainties regarding applicability outside of Massachusetts.

But the study's findings align with prior research on telehealth's impact on mental healthcare access and use.

A report from October indicated that patients see various benefits in using telehealth for primary and mental healthcare. The report detailed a survey of over 1,000 patients, which showed that telehealth use fell following the return to in-person healthcare.

But, among the healthcare consumers open to continuing telehealth use, most preferred virtual visits for primary care (55 percent) and mental healthcare (45 percent).

The report also found that telehealth satisfaction was high, with many survey respondents indicating that their telehealth experience was positive.

Earlier this year, clinicians spoke with mHealthIntelligence about how telehealth can help close pediatric mental healthcare gaps. They detailed strategies and key considerations for expanding telehealth access.

One prominent strategy for expanding pediatric mental healthcare access is to bolster the behavioral health workforce, the clinicians said. Resources such as telepsychiatry can help extend the workforce to meet the increased demand for child psychiatrists during the COVID-19 pandemic.