Telehealth-Focused Practices Offer Medicare Patients With SMI 13% More Visits

During the pandemic, Medicare patients with serious mental illness who accessed care at practices that mainly used telehealth had 13% more mental health visits than those mainly receiving in-person care.

However, researchers found no changes in these patients’ medication adherence, hospital and emergency department use or mortality, according to a recent study published in JAMA. Researchers say this could be promising for using telehealth with SMI populations.

“Our results suggest that, during a period when practices rapidly adopted telemedicine, patients in practices with a high use of telemedicine had more visits with their clinicians and did not appear to experience some of the adverse outcomes that might be expected if telemedicine visits were a poor substitute for in-person care,” authors of the study wrote.


The study included a cohort of 120,050 Medicare fee-for-service beneficiaries with schizophrenia or bipolar I disorder. Researchers categorized practices into three levels of telehealth use: low, medium and high.

Researchers found that, on average, patients who accessed care at high telehealth use practices more often had at least one mental health visit every six months and less often had no visits in year two.

“We interpreted the increase in mental health visits as a favorable change given known access barriers among patients with SMI and the importance of continuity of care in this population,” authors of the report wrote. “The important caveat is that the increase in mental health visits that we observed was not associated with increased medication adherence or fewer hospitalizations or ED visits.”


However, this increase in visits was not universal in the cohort. Researchers noted that they did not observe greater increases in mental health visits among specific subgroups, including patients with low income and those living in rural areas.

Since the COVID-19 pandemic, there has been a significant increase in virtual care for behavioral health conditions. While many of the newer companies coming on the market cater to patients with less acute behavioral health conditions such as anxiety or mild depression, more providers are beginning to use virtual care for patients with SMI.

Even traditional brick-and-mortar companies are seeing a significant uptick of telehealth services. For example, LifeStance Health Group Inc. (Nasdaq: LFST), one of the largest outpatient behavioral health providers in the country, reported that virtual visits accounted for nearly three-quarters of the organization’s total overall visits in Q2.

“Using telemedicine to care for patients with SMI may be an effective policy for provider organizations or health plans to improve patient-clinician engagement and continuity of care, which may help these patients better manage their conditions,” authors of the study wrote.

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