Demand for and utilization of behavioral health is growing, yet declining in the rest of health care.
Omitting care for COVID-19, behavioral health visit volume is 16.8% above while volume for all other health care services volume is 6.2% below pre-pandemic levels. The report compared care levels during the first quarters of 2019 and 2022.
Behavioral health appears to be not nearly as affected by what a new report by Trilliant Health calls an “illusory volume rebound” in health care. While the behavioral pressures of the pandemic have, on average, driven more people to the behavioral health sector, it has driven people out of primary care, urgent care and surgical centers.
The report asserts that the care that hasn’t happened during the pandemic is forgone, rather than delayed.
“Americans have been slow to return to primary care and preventive screenings post-pandemic, and many of those who have returned are choosing urgent care and retail clinics in lieu of traditional primary care providers,” Trilliant Health CEO Hal Andrews said in a news release.
Behavioral health volumes reached a peak in the second quarter of 2021 at about 81 million visits. Visits for the first quarter of 2022 totaled 79.5 million.
Demand shifted up and down across different regions. Still, 69.5% of all metros studied saw increases in utilization. Across metros, demand increased by 14.1% reflecting steep declines in a few markets.
Some of the fastest-growing metros saw some of the largest decreases. The San Antonio-New Braunfels and the Houston-The Woodlands-Sugar Land metros, both in Texas, saw decreases of 21.1% and 1.9%, respectively. All of the slowest-growing metros tracked saw demand increases with the notable exception of the Urban Honolulu, Hawai’i metro seeing a 30.2% decrease.
The largest increase was in the Rochester, New York metro with an increase of utilization of 60.3%.
Like with metros, behavioral health utilization was not universal across age, gender and insurance demographics.
Female patients increased their utilization of behavioral health services by 26.2%, almost four times the rate of increase of male utilization.
The traditional working age demographic of those ages 18 to 64 similarly saw a wide gap between increases of behavioral health utilization compared to other age cohorts. This group saw a 25.4% increase compared to pre-pandemic level while those 17 and younger saw a 7.4% increase and those 65% and older saw a 5.6% increase.
People with Medicaid increased behavioral health utilization by 11.8% while those with Medicare decreased utilization by 1.5%. Commercial health plan enrollees saw the largest increase by payer type: 24.2%.
Telehealth continues to have special relevance to behavioral health especially compared with the rest of health care, according to the report.
Demand for telehealth services in all other health care services dipped by 37% in the first quarter of 2022 compared to its peak in 2020.
However, telehealth utilization in behavioral health remains steady. Of all telehealth visits, 59.9% were for behavioral health reasons in the first quarter of 2022. In the first quarter of 2019, behavioral health made up 32.4% of telehealth visits.
Trilliant Health ties changes in telehealth utilization in behavioral health to changes in prescribing of related medications which is also on the rise.
In 2021, antidepressant and antianxiety prescribing represented 18.9% of seven selected drug classes analyzed. These medications surpassed opioids (15.4%) as the second most prescribed medication in 2021. The seven-drug cohort totaled about 98 million prescriptions.
In 2019, antidepressants and antianxiety medications made up about 17.4 of prescriptions tracked in 2019, the report states.
The report aggregates third-party resources and Trilliant Health’s proprietary all-payer claims database that informs longitudinal patient journeys for more than 300 million Americans.
Outside of behavioral health, the report identifies a decrease in the number of Americans with commercial health insurance, the rise of powerful retail entities (Amazon, CVS Health and Walmart) and a decreasing total addressable market in health care.
“For decades, commercially insured patients have been the lifeblood of the health economy, and the secular decline in the percentage of that group is detrimental for every health economy stakeholder,” Andrews said. “As leading retailers and payers begin to commoditize low-acuity services and the Congressional Budget Office analyzes the effect of price caps on medical reimbursement, the business model of every health economy stakeholder is pressured.”
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