Behavioral health utilization is accelerating even as other levels of care are diminishing in the wake of the COVID pandemic.
A new report from the health care data and services company Trilliant Health shows that behavioral health utilization in the U.S. was up 40% in 2023 compared to 2019. Utilization is also accelerating.
Behavioral health utilization increased 13% year over year in 2023, but only 5% year over year in 2022.
At the same time, primary care utilization is lower than it was before the pandemic, down 12% in 2023 compared to the pre-pandemic era. It’s also down 4% in 2023 year over year.
These and other key data points are vital for defining the landscape of health care and behavioral health’s place in it, Trilliant Health Chief Research Officer Sanjula Jain said in a news release.
“Every knowledgeable stakeholder must acknowledge that the inputs of the U.S. healthcare system, as measured by cost, exceed the outputs, as measured by the actual value or benefits received by Americans,” Jain said. “Every stakeholder can — and must — deliver more value for money to their customers.”
The report paints a critical picture of the overall health system, demonstrating that for the planet-leading expenses Americans and their institutions pay for health care, they get much poorer health outcomes.
It also shows that administrative costs are on the rise. For hospitals, these costs are growing faster than even the costs to provide care for patients.
It also projects that health status will continue to decline, pointing to the reduction in primary care and the increase in behavioral health utilization to support this thesis.
All behavioral health-related conditions see increasing treatment utilization, some more than others. The patient volumes for eating disorders and schizophrenia were up about 14% in the fourth quarter of 2023 compared to the first quarter of 2019. Schizophrenia patient volumes have increased fastest of all the conditions examined. Eating disorder treatment patient volumes have been historically high since the third quarter of 2020.
Part of the impact of this falls not on behavioral health providers directly but on hospitals and their emergency rooms.
“Through EMTALA, the federal government has effectively delegated to hospitals the responsibility for dealing with a host of societal ills that manifest in clinical conditions, particularly the nation’s burgeoning behavioral health crisis that presents daily in every emergency department in the country,” the report states.
The report also reflects other findings about patients’ struggles using behavioral health benefit usage: 14% of patients received behavioral health on an out-of-network basis for behavioral health compared to 2% for physical health care.
Health plans can also go from not enabling care to being a barrier to it, the report states. Thirty-seven percent of patients said they stopped going to therapy because their health plan stopped covering it. That was the top financial barrier to care. The second-most-common barrier to care was that it was “too expensive,” at 22%.
Telehealth continues to be used predominantly for behavioral health conditions, even as other care uses diminish. The high use of telehealth by behavioral health providers calls into question the prevailing narrative that patients are pushing for in-person experiences.
“Telehealth utilization trends signal that patients do not view telehealth as a substitute for in-person care for most conditions, except for behavioral health,” the report states. “How telehealth utilization evolves will depend on how policymakers, employers, payers and providers view its clinical utility, which can be at odds with patient, or consumer, preference.”
Within telehealth specifically, behavioral health accounted for about 72% of all visits in the fourth quarter of 2023.