Virtual Behavioral Health, Ambulatory Care Spiked During Pandemic

Virtual visits for ambulatory care and behavioral health services increased during the pandemic, while in-person visits declined, according to a JAMA Network Open study.

Payers and providers loosened restrictions on telehealth services during the pandemic to provide an alternate means of healthcare delivery for patients that limited COVID-19 exposure.

Researchers from Massachusetts General Hospital and Harvard Medical School analyzed all ambulatory visits at 12 New England hospitals and their outpatient sites that took place between October 1, 2019 and April 30, 2021. Visit types included in-person visits onsite, in-person visits at home, and virtual visits.

Researchers also paid attention to the frequency of behavioral health visits to understand if the pandemic impacted utilization patterns.

The analysis consisted of 10,559,857 ambulatory care visits from 1,530,772 patients. Just over half of the patients attended only in-person visits during the study period, while 41 percent attended in-person and virtual visits and 6 percent, or 91,846 patients, only had virtual visits. For the patients who had both visit types, 76.2 percent of the visits were in-person either onsite or at home and 23.8 percent of the visits were virtual.

Although in-person visits were more common overall compared to virtual visits, the number of in-person visits declined significantly when the pandemic hit, with April and May of 2020 bringing particularly low numbers, researchers found.

Meanwhile, the number of virtual visits increased at the beginning of the pandemic and stayed steady throughout the remaining months of the study period.

With the decrease in in-person visits and the increase in telehealth visits, there was no significant change in the overall volume of visits, suggesting that virtual care was substitutive, not additive, in the ambulatory care setting, the researchers indicated.

“We are unable to quantify the true amount of care needed by patients during this time, but it is likely that virtual care offerings lowered barriers in access to care during the period of limited in-person gatherings,” the study stated.

While the overall visit volume remained mostly unchanged, there was a small increase in the number of behavioral health visits. Between October 2019 and February 2020, the mean monthly behavioral health visit volume was 29,609. Between June 2020 and April 2021, the mean visit volume increased to 36,901.

The majority (94 percent) of the monthly visits after May 2020 were virtual, the study noted, indicating that telehealth was responsible in part for the uptick in behavioral healthcare services.

The need for mental and behavioral healthcare increased during the pandemic. Behavioral health services also became more accessible during this time with new opportunities to receive care via telehealth.

The study results may provide reassurance to providers and payers that telehealth is useful, convenient, and popular among patients. Telehealth services have benefitted patients and providers in rural areas, and have helped close care gaps by eliminating barriers to care like transportation.

Telehealth remains a valuable option for healthcare delivery as the pandemic continues. Additionally, stakeholders want to keep using virtual care in a post-pandemic world.