UPMC Sees Virtual Behavioral Health Surge from Patients With Commercial Insurance, Sees Opportunity for MAT Services

More people are comfortable using telehealth as behavioral health services utilization has taken off from commercially-insured patients, according to one major health system.

University of Pittsburgh Medical Center (UPMC), whose provider network encompasses 140 hospitals throughout Pennsylvania – as well as in parts of Ohio, West Virginia and Maryland – said its behavioral health volume is surging on the commercial side during a virtual event from America’s Health Insurance Plans (AHIP).

“There was significant use [of telehealth] in Medicare and Medicaid populations, but definitely less than commercial,” said James Schuster, the chief medical officer of UPMC’s insurance services division. “Commercial is really where it went up. 70% or 80% of all our behavioral health visits in the commercial product are telehealth in nature.”


Telehealth usage has jumped 38X since 2020, according to McKinsey & Company. During the pandemic, a number of rules have been relaxed at the state and federal level to allow for more telehealth to be provided across state lines.

Government insurance recipients are now allowed to receive telebehavioral health in their homes to accommodate the demand for services. And a number of bipartisan legislative efforts continue to advocate for more temporary telehealth flexibilities to be made permanent.

Schuster said that UPMC is developing guidelines to account for in-person behavioral health care being provided and reimbursed – which would seem to fall in line with the federal government’s current wishes that in-person care not be done away with altogether.


Those guidelines, in Schuster’s opinion, are fluid.

“We really don’t see ourselves necessarily developing explicit guidelines as a payer, but certainly having some general guidelines about making sure that services that need to be done in-person are [done],” he said. “I think the definition is that it’s going to continue to change over time.”

Schuster also said he is encouraged about the use of telehealth to render addiction treatment services. For the first time last August, SUD diagnoses became one of the top five treatment claim lines for which telehealth was used.

A number of SUD treatment startups such as Quit Genius and Workit Health have been busy pulling in funding within the last year – respectively raising $64 million and $118 million – along with Ophelia Health, which initially scored $15 million last April before bringing in $50 million to close out 2021. Additionally, longtime addiction treatment organizations like the Hazelden Betty Ford Foundation have leaned into telehealth, as the provider has plans to make it available in all 50 states in the coming years.

Schuster said that UPMC’s insurance division – which covers close to 4 million individuals – has partnered with the health system’s provider side to offer telehealth SUD treatment during the pandemic, and is seeing success with medication-assisted treatment.

“We’ve been particularly gratified by the experience we’ve had with starting medication-assisted treatment over telehealth,” he said.

Citing published studies, Schuster did acknowledge that it can be hard for some people to interact digitally with health care services.

“It’s very difficult to get people engaged in digital tools unless you have some concurrent interaction with a person, whether that be with a therapist or with a coach,” he said.

Ultimately, Schuster is confident that the industry is adapting to make the telehealth experience more user-friendly and with a personal touch.

“I think everyone’s experience during the pandemic in general made us all more comfortable that more can be done via a tele-platform than what at least most of us thought it would be prior to the pandemic,” he said.

Companies featured in this article:

, , , , , ,