Mental health spend, aided by telehealth, surged during the pandemic

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Rapid expansion of telehealth services for mental health conditions at the onset of the COVID-19 pandemic helped improve access to care and improved provider ability to meet patient demand, according to a study published in JAMA Health Forum. 

The report claimed many mental health treatments can effectively be administered remotely -- in contrast to physical health services, which may require examinations and fixed-in-place medical equipment.

To determine more precisely how mental telehealth services were used, researchers from RAND conducted a study to assess utilization and spending rates among commercially insured adults in the U.S. between 2019 and 2022, utilizing data from approximately seven million commercially insured adults.

Three distinct periods were examined: before the public health emergency (PHE) declaration (January 1, 2019 to March 12, 2020), during the acute phase prior to vaccine availability (March 13 to December 17, 2020) and the post-acute phase (December 18, 2020 to August 31, 2022).

During the acute phase of the pandemic, in-person visits for mental health services dropped by 39.5%, while telehealth visits surged remarkably by 1019.3% compared to the previous year. 

The combined effect led to an overall increase of 22.3% in service utilization across the spectrum of conditions -- a trend which remained consistent across conditions.

In the subsequent post-acute phase, telehealth visits stabilized at around 10 times the pre-pandemic levels, while in-person visits exhibited a 2.2% monthly increase over the period.

Spending rates mirrored the utilization trends, with per capita expenditures for mental health services seeing a nearly 30% increase during the acute phase compared to the previous year.

After the acute phase, while spending on telehealth services remained stable, spending on in-person care returned to pre-pandemic levels.

By August 2022, in-person visits recovered to 80% of their pre-pandemic levels, resulting in a nearly 40% overall increase in mental health service utilization compared to the pre-pandemic era.

WHY THIS MATTERS

The report argued the demand for mental health services underscores the critical need to integrate behavioral health services into primary care, with the findings indicating a sustained and elevated utilization of telehealth services for mental health needs, with corresponding increases in spending.

The report noted the termination of the national PHE declaration raises questions about the future trajectory of telehealth coverage by insurers and its influence on the evolving landscape of mental health services.

Bipartisan legislation recently introduced on Capitol Hill aims to improve the coordination of mental and physical healthcare with funding and guidance to spur wider adoption of electronic health records for behavioral health providers.

THE LARGER TREND

Healthcare roles focused on mental health are among the top 50 most in-demand healthcare jobs in the US, according to research from job search engine Adzuna.

Various organizations have explored telepsychiatry and hybrid group therapy to offer more options for patients seeking mental health support.

Virtual care provider Ophelia has found telehealth to be a successful method for opioid use disorder treatment, with retention rates significantly higher than with traditional in-person care.

In July, a health technology project in Hong Kong received significant public funding to introduce an AI-based data-driven approach to mental health diagnosis and treatment.

ON THE RECORD

"If greater utilization of health services drives higher health care spending, insurers may begin pushing back on the new status quo," Jonathan Cantor, lead author of the study and a policy researcher at RAND, a nonprofit research organization, said in a statement. "Insurers may look for ways to curb costs and that could mean less flexibility about using telehealth for mental health services."