COVID-19, State Policies Made Telehealth a Permanent Feature of Behavioral Health, New Research Suggests

Telehealth is here to stay in behavioral health. Data proves that.

But questions remain about what telehealth in behavioral health will look like going forward. Where is it most effective? Who does or doesn’t benefit from it? What systemic issues prevent it from helping those who truly need its benefits?

The following research helps answer some of those and other questions.

Increased telehealth utilization in mental health — a durable change

Telehealth visits for mental health grew 84 times higher in 2022 compared to 2019.

Further, usage within mental health is only down 5% in 2022 compared to 2021, the beginning of the end of the most acute phase of the COVID-19 pandemic. Across all health care, telehealth utilization is down 18% for the same period, according to LexisNexis Risk Solutions.

These insights and others are based on an analysis of “over a billion de-identified medical claims,” according to a recently published brief from the organization.

“Coming out of the pandemic, the surge in telehealth utilization has slowed, but it’s clear that telehealth is here to stay,” the brief states. “Usage patterns show that telehealth addresses critical challenges around perceived stigmas, especially for mental health, and access in an already understaffed and overburdened care delivery system.”

Across all ages, telehealth visits for stress/adjustment disorders, anxiety and depression increased the most. Visits in 2022 were up 60% for stress/adjustment disorders, 51% for anxiety and 37% for depression.

For those aged 17 and younger, the conditions with the largest growth in telehealth visits were eating disorders, depression and anxiety. Visits for eating disorders have more than doubled.

Young adults, aged 18 to 44, saw the largest increase in telehealth utilization for mental health at 81%. That usage falls off for those who are younger. Teen and children utilization increased by 36%. The average increase across all age groups was 56%.

These findings are similar to others about the impact and durability of telehealth in the behavioral health industry.

State policies connected to telehealth availability

Researchers with the RAND Corporation and Harvard Medical School found that four state policies adopted during the COVID-19 pandemic "were associated with increased odds of telehealth availability."

The study also found that access disparities persisted in counties that had comparatively larger Black populations and populations of those insured by Medicaid, inclusive of the Children’s Health Insurance Program (CHIP).

The four policies the researchers examined were:

— Payment parity for telehealth services among private insurers

— Authorization of audio-only telehealth services for Medicaid

— Participation in the Interstate Medical Licensure Compact (IMLC)

— Participation in the Psychology Interjurisdictional Compact (PSYPACT)

The analysis included 12,828 mental health care facilities. Overall, 88% of facilities offered telehealth services in September 2022, compared to 39% in April 2019.

Facilities in states with telehealth parity rules had 11% higher odds of offering telehealth services; Medicaid reimbursement for audio-only services increased odds by 73%; Participation in the IMLC and the PSYPACT increased the odds by 40% and 21%, respectively.

However, facilities that accepted Medicaid had 25% lower odds of offering telehealth compared to those that did not. Those in counties with a 20% or higher portion of the population being Black saw 42% lower odds.

"In this national cohort study, four state policies were associated with a consistently greater likelihood of telehealth availability at mental health treatment facilities in the US. Despite these policies, certain groups remained underserved," the study states. "This finding underscores the need for targeted local legislation that could sustain and further expand access to telehealth services."

Addiction treatment disparities not worsened by state policies

One recent study investigated whether new telehealth policies in response to the COVID-19 pandemic changed addiction treatment utilization.

The answer, in short, is no.

Care initiation actually increased for most populations, with the exception of patients aged 50 and older, the study found.

"Results of this study suggest that disparities in addiction treatment utilization were not exacerbated following expansion of telehealth during the early phase of the COVID-19 pandemic," the study states.

The cohort study was based on electronic health record data and claims data from Kaiser Permanente Northern California for adults with "drug use problems." It looked at two timespans: a pre-pandemic phase (March 1, 2019, to Dec. 31, 2019) and an early pandemic phase (March 1, 2020, to Dec. 31, 2020).

The greatest benefit of the telehealth policies, in terms of the likelihood to initiate treatment before and after the onset of the pandemic and the resultant policies, is seen among young people, aged 18 to 34. This group had a 7 times higher likelihood of initiating treatment via telehealth.

Even when looking at overall treatment initiation, young people were 31% more likely to initiate treatment during the early pandemic phase compared to the pre-pandemic phase.

"Overall treatment initiation increased, with no significant variation for all race and ethnicity groups and [neighborhood deprivation index] quartiles," the study states.