Patients less likely to seek virtual behavioral care when paying out-of-pocket

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Patients in high-deductible health plans are less likely to seek telemental health visits when required to pay out-of-pocket, according to an Included Health and Harvard Medical School study published in JAMA Network Open.

The cohort study included patients from all 50 states and Washington, D.C., receiving telemental healthcare from Included Health from two clients – one employer and one insurance plan that varied in their coverage of telemental health during the study period. Included Health is a national telehealth-only company.

During the study period, from January 1, 2021 to June 30, 2021, all patients had no cost sharing for telehealth visits. In July 2021, one client reintroduced cost sharing, and the other client – the control – continued to offer telehealth services without cost sharing.

After the reintroduction of cost sharing, the mean number of visits per patient per month was lower in the intervention group than the control group. 

When patients were required to pay out-of-pocket for telehealth visits, they had substantially fewer telemental health visits, and a larger fraction stopped seeing their mental health specialists. Authors said the findings imply that the expiration of the predeductible telehealth coverage exception in January 2025 may reduce mental health service use, which could lead to worse clinical outcomes.

WHAT'S THE IMPACT?

The marked increase in telehealth visits during the COVID-19 pandemic, particularly for mental health, was bolstered by regulatory changes such as the exemption of telehealth visits from the deductible in high-deductible health plans – plans in which individuals face a minimum $1,600 deductible.

Congress extended this exemption through the end of 2024, and authors noted there's ongoing debate on whether the exemption should be made permanent.

They determined their findings are consistent with a robust body of research showing that patient cost sharing decreases the use of both high- and low-value care. 

Given ongoing concerns about access to mental health treatment, and to help patients stay in treatment, policies that reduce cost sharing for both in-person and telemental health visits should be considered, they said, though they stopped short of issuing specific policy recommendations.

THE LARGER TREND

In May the House and Ways Committee passed telehealth legislation to preserve flexibilities for virtual care introduced during the COVID-19 pandemic. The Preserving Telehealth, Hospital, and Ambulance Access Act, introduced by Rep. David Schweikert, R-Ariz., and Rep. Mike Thompson, D-Calif., expands Medicare telehealth for two years, hospital-at-home flexibilities for five years and Medicare supplemental payments for rural hospitals and ambulance services.

The bill proposes to preserve Medicare patients' access to vital telehealth for two years and hospital-at-home services for five years. Twenty-five percent of adults report having utilized telehealth in the past month, and 78% are likely to complete a medical appointment via telehealth again, according to Ways and Means.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.