Telehealth Has Played an Outsized Role Meeting Mental Health Needs During the COVID-19 Pandemic


There was a fast enhance in the usage of telehealth so far into the COVID-19 pandemic for each psychological and bodily well being issues. Whereas many employer well being plans lined telehealth previous to the pandemic, utilization of those companies was comparatively low, accounting for lower than 1% of outpatient visits. At its pandemic peak, telehealth represented 13% of outpatient visits between March and August of 2020. As in-person care resumed, telehealth started to characterize a smaller share of outpatient care (8% between March and August 2021). Whereas many continue to examine an expanded position for telehealth within the supply of care following the pandemic, there stays appreciable uncertainty in what companies will likely be obtainable, the place and the way suppliers will have the ability to follow, how advantages will likely be structured, and the way suppliers will likely be paid.

The COVID-19 pandemic has taken a toll on the nation’s psychological well being, with 3 in 10 adults within the U.S. reporting signs in line with despair or anxiousness dysfunction since April 2020. Over 20% of adults reporting poor psychological well being additionally report not receiving counseling or remedy throughout the pandemic. Telehealth has performed a very important position in assembly the necessity for psychological well being companies. Up to now into the pandemic, some personal payers have improved protection for psychological well being and substance use, eradicating pre-pandemic restrictions on protection for these companies through telehealth. Equally, Medicaid expanded protection of telehealth companies throughout the pandemic for psychological well being and substance use companies. Many state Medicaid applications reported that telehealth has had explicit worth in sustaining or enhancing entry to such companies throughout the pandemic.

This evaluation appears to be like at outpatient visits throughout 5 six-month durations between March 2019 and August 2021, utilizing knowledge from Cosmos, a HIPAA-defined Restricted Knowledge Set of greater than 126 million sufferers from over 156 Epic organizations, together with 889 hospitals and 19,420 clinics throughout all 50 states. Psychological well being and substance use visits have been recognized based mostly on the first ICD-10-CM analysis code listed for the go to. We discover {that a} yr and a half into the pandemic, telehealth continues to play a big position in offering companies, notably for psychological well being and substance use companies.

Psychological well being and substance use companies by telehealth has remained elevated whereas different outpatient care use by telehealth has declined

Telehealth represented lower than 1% of outpatient care earlier than the pandemic (rounding to zero) for each psychological well being and substance use and different issues. Nevertheless, at its pandemic peak, telehealth represented 40% of psychological well being and substance use outpatient visits and 11% of different visits (throughout the March- August 2020 interval). Since then, in-person care has returned and telehealth visits have dropped off to characterize 5% of different outpatient care visits, these with no psychological well being or substance use declare within the March-August 2021 interval. Nevertheless, telehealth use has remained robust for psychological well being and substance use therapy, nonetheless representing 36% of those outpatient visits.

Telehealth use for psychological well being or substance use continues to develop as a share of all telehealth visits

Psychological well being and substance use visits characterize a rising share of each telehealth visits and outpatient visits general, however the development is way more pronounced for telehealth. By the interval of March-August 2021, 39% of telehealth outpatient visits have been primarily for a psychological well being or substance use analysis in comparison with 24% a yr earlier and 11% two years earlier. Amongst all outpatient visits (in-person and over telehealth), the share with a psychological or substance use analysis grew from 4% in March-August 2019 to eight% throughout the pandemic, and has remained at 8% in March-August 2021.

This can be a product of a number of elements, together with the large increase in need for psychological well being companies because of the pandemic, social distancing and ensuing financial turmoil, in addition to a return to in-person visits for different outpatient care.

Rural residents are extra seemingly to make use of telehealth for psychological and substance use dysfunction visits

The adoption of telehealth varies based mostly on the well being wants of sufferers, their readiness and talent to undertake the know-how, and the restrictions or incentives they face from payers and suppliers. Taking a look at the newest examine interval (March-August 2021), a comparatively excessive share of sufferers in rural areas relied on telehealth to obtain outpatient psychological well being and substance use companies (55%) in comparison with these in city areas (35%). This sample is particularly pronounced compared to different outpatient well being care companies, the place we noticed an analogous price throughout city and rural (5% vs. 6%) areas. This can be impacted by the variety of rural areas which have a shortage of psychological well being suppliers.

Non-elderly adults persistently used telehealth to entry psychological well being and substance use companies

Early on within the pandemic (March-August 2020), outpatient companies for psychological well being and substance use have been delivered by telehealth at an analogous price amongst kids and the aged, and a barely decrease price amongst non-elderly adults. A yr later (March-August 2021), non-elderly adults have been considerably extra more likely to be handled through telehealth in comparison with youngsters and seniors. In the newest interval, 58% of all psychological well being or substance use outpatient visits, and 62% of those visits carried out through telehealth, have been amongst individuals within the 19-64 age group.

Telehealth use is important throughout main psychological well being and substance use dysfunction situations

The first ICD-10-CM analysis code listed on an outpatient go to was categorized into situations based mostly on the Medical Classifications Software program Refined (CCSR). Main situations have been chosen if there have been greater than 5,000 whole visits (in-person and telehealth) throughout the March-August 2021 interval. A big share of outpatient visits for main psychological and substance use situations have been delivered over telehealth throughout this era, together with for substance use issues comparable to opioid-related issues (29%) and alcohol-related issues (29%). For psychological well being wants, over 1 in 3 outpatient visits have been delivered by telehealth (for instance, 35% and 38% of outpatient visits have been over telehealth for despair or anxiousness, respectively).

Dialogue

How the mass adoption of telehealth affects access, cost, and quality of psychological well being and substance use dysfunction companies stays to be seen. Telehealth might present a manner to enhance entry to psychological well being and substance use dysfunction care, notably for individuals dwelling in areas with fewer suppliers. Although variations in consolation with know-how, digital literacy and lack of internet at house might hinder entry to telehealth for some.

Payers’ and regulators’ policies governing telehealth companies proceed to evolve. As required beneath the Consolidated Appropriations Act of 2021 (CAA), and as carried out beneath the CY 2022 Medicare Doctor Charge Schedule Final Rule, Medicare has completely eliminated geographic restrictions for psychological well being and substance use companies and completely permits beneficiaries to obtain these companies at house. Additionally beneath the Doctor Charge Schedule last rule, CMS will now completely cowl audio-only visits for psychological well being and substance use companies, although solely when the beneficiary just isn’t able to, or doesn’t consent to, the usage of two-way, audio/video know-how.

States have broad flexibility to find out Medicaid protection of telehealth companies in addition to suppliers’ licensure necessities to follow and prescribe throughout a telehealth session. States expanded Medicaid telehealth protection in response to the pandemic, with almost all states masking and paying parity for audio-visual and audio-only mental health and substance use dysfunction visits of their fee-for-service Medicaid applications as of July 2021. Many states plan to keep up all or a few of these expanded telehealth insurance policies post-pandemic, particularly flexibilities for behavioral well being visits. Nevertheless, some states have moved to reinstate sure guidelines that restrict telehealth use, suppliers’ capacity to follow throughout state traces, and suppliers’ capacity to prescribe treatment with out an in-person go to. In another states, telehealth protection expansions for Medicaid are tied to the COVID-19 public well being emergency (PHE) and can expire with the PHE until prolonged. State and federal legal guidelines concerning suppliers’ talents to prescribe treatment through telehealth and follow throughout state traces will even have an effect on telehealth use sooner or later. Short-term federal policies that gave certified suppliers extra flexibility to prescribe managed substances over telehealth are set to run out on the finish of the PHE.

Knowledge throughout the pandemic counsel there’s a regarding enhance within the variety of people reporting signs of despair or anxiousness and exhibiting indicators of substance use disorder. Many employers have expressed concern in regards to the availability of psychological well being suppliers of their plan network. Given the elevated want for companies and issues in regards to the availability of psychological well being and substance use care suppliers, some payers might look to bolster entry to those companies by telehealth.

As coverage makers proceed to take a look at how one can regulate and pay for telehealth companies, you will need to take into account alternatives for affected person selection in order that telehealth just isn’t essentially given as the one choice for these searching for care. Moreover, the Substance Abuse and Psychological Well being Providers Administration (SAMHSA) has referred to as for refining medical tips for tele-mental well being companies, together with broader adoption of telehealth for psychological and substance use issues. Specifically, how legal guidelines affecting prescribing patterns for psychological well being and substance use therapies are devised after the COVID-19 public well being emergency ends might affect the long-term use of telehealth for psychological well being and substance use issues.

Justin Lo is with Epic Analysis. Matthew Rae, Krutika Amin, Cynthia Cox, and Nirmita Panchal are with KFF. Ben Miller is with Nicely Being Belief.

This evaluation was achieved utilizing Epic’s Cosmos dataset, a HIPAA-defined restricted knowledge set of digital well being data from over 150 Epic organizations. Estimates on this report are based mostly on this inhabitants and never weighted to be nationally consultant. The evaluation used knowledge on outpatient visits for 94 knowledge contributors to Cosmos from March 1, 2019 by August 31, 2021 and was analyzed in 6-month durations. Psychological well being and substance use companies delivered by third-party distributors might not be included.  Organizations have been then excluded if that they had software program go-lives or mergers throughout the examine time interval, had a number of weeks of lacking knowledge, or confirmed discrepancies. Psychological well being and substance use visits have been recognized based mostly on the first ICD-10-CM analysis code listed on the outpatient go to. Major analysis codes have been then grouped based mostly on the Company for Healthcare Analysis and High quality (AHRQ) Medical Classifications Software program Refined (CCSR) grouping. Rural sufferers are those that don’t reside in a core based mostly statistical space (CBSA).

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