Telehealth filling critical need for pediatric mental health, study finds

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Pediatric telehealth for mental health needs filled a critical deficit in the immediate period following the emergence of COVID-19, and continues to account for a substantial portion of pediatric mental health service utilization and spending, according to a new research letter in JAMA Network Open.

Because of that, commercial health insurers should use telehealth to make up for the lack of mental health providers focusing on youth, the research determined.

Focusing on children and youths younger than 19 who have received common pediatric mental health diagnoses (anxiety, adjustment disorder, attention-deficit/hyperactivity disorder, etc.), the team quantifies trends and changes in monthly utilization and spending rates between three phases of COVID-19: pre-pandemic, the midst of the pandemic before vaccine availability, and post-pandemic. 

Monthly medical claims data provided by Castlight Health were used to measure trends in utilization per 1,000 beneficiaries and spending (accounting for inflation by indexing 2020 to 2022 rates to 2019) per 10,000 beneficiaries among roughly 1.9 million children and youths with commercial insurance throughout the U.S.

Utilization and spending trends were generally consistent across pediatric mental health diagnoses. Compared with pre-pandemic, in-person pediatric mental health services declined by 42% during the pandemic's acute phase, while pediatric telehealth services increased 30-fold (3,027%), representing a 13% relative increase in overall utilization.

By August 2022, in-person services returned to 75% of pre-pandemic levels and telemental health utilization was 2,300% higher than pre-pandemic levels.

During the post-pandemic period, there was a gradual increase in spending rates compared with pre-pandemic for in-person, telehealth and total visits. From January 2019 to August 2022, mental health service utilization increased by 21.7%, while mental health spending rates increased by 26.1%.

WHAT'S THE IMPACT?

The COVID-19 pandemic severely tested the mental health of children and youths due to unprecedented school closures, social isolation and distancing, and COVID-19-related mortality among families, according to research in JAMA Pediatrics. 

In response, health systems offered telehealth to increase access to pediatric mental healthcare, but the extent to which telehealth availability led to greater utilization and spending was largely unknown.

As it turns out, utilization and spending increased over the entire timeframe. ADHD, anxiety disorders, and adjustment disorder accounted for most visits and spending in all phases.

Supported by evidence that telehealth can effectively deliver mental health treatment for children and youths, the findings have important implications for telehealth sustainability beyond the effects of COVID-19, authors said.

THE LARGER TREND

A stark generation gap has emerged between millennials and baby boomers when it comes to telehealth, with younger patients driving the highest overall satisfaction scores and older patients experiencing significantly lower levels of satisfaction, according to the J.D. Power 2023 U.S. Telehealth Satisfaction Study, published last month.

The satisfaction gap is widest in digital channels and appointment scheduling, suggesting that older telehealth users are having problems using telehealth providers' digital interfaces.

Also in September, Epic Research determined that despite being able to be reimbursed for telehealth services at the higher facility rate for another year, providers are frequently billing for these virtual visits at a lower level-of-service code, a trend that holds true for both primary and specialty care. Telehealth visits are more frequently coded with a lower level-of-service billing code than in-person office visits of the same specialty.

In October 2022, after three months of relative stability, national telehealth utilization declined 3.7%. Looking at one specific metric, telehealth went from 5.4% of medical claim lines in September, to 5.2% in October, according to FAIR Health's Monthly Telehealth Regional Tracker.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com