News — A recent study conducted by the RAND Corporation found that during the COVID-19 pandemic, the implementation of four state policies aimed at promoting telehealth expansion led to an increase in telehealth services provided by mental health facilities. However, facilities located in counties with a higher percentage of Black residents experienced comparatively less growth in telehealth services.
According to the study, telehealth expansion was also limited among facilities that accepted Medicaid or the Children's Health Insurance Program (CHIP), both of which are government insurance programs that primarily assist lower-income Americans.
The study, published in the journal JAMA Network Open, reveals that despite the significant growth of telehealth services during the pandemic, disparities in access to mental health care remained.
Ryan McBain, the lead author of the study and a policy researcher at RAND, a nonprofit research organization, emphasized the significance of state policies in enhancing access to mental health care. McBain stated, "Our findings indicate that the expansion of telehealth is facilitated by state policies, and it is crucial to maintain these policies to sustain the progress made. Additionally, targeted legislation at the local level is necessary to address disparities in access."
The primary objective of the RAND researchers was to examine the relationship between state-level policies and the subsequent expansion of telehealth following the onset of the COVID-19 pandemic.
The research centered on four measures: equal payment for in-person and telehealth services by private insurers; approval of audio-only telehealth services for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries; involvement in the Interstate License Exchange Program, enabling psychiatrists to offer services across state borders; involvement in the Psychology Interjurisdictional Compact, enabling clinical psychologists to offer services across state borders.
To assess the effects of these policies on telehealth services in mental health facilities, analysts examined data obtained from the Mental Health and Addiction Treatment Tracking Repository concerning over 12,000 facilities. Their examination was restricted to outpatient facilities, as they have a significant influence on telehealthcare.
During the timeframe spanning from April 2019 to September 2022, the study discovered a substantial increase in the proportion of mental health treatment facilities providing telehealth services. The percentage surged from 39% to 88%, more than doubling in the given period.
Throughout the duration of the study, there was a notable escalation in the number of states implementing payment parity legislation, rising from six to 28. Additionally, the number of states with audio-only payment policies experienced a significant increase, growing from zero to 33. The count of states permitting psychiatrists to practice across state lines expanded from 28 to 38, while those permitting clinical psychologists to practice across state lines surged from seven to 32.
The researchers observed a significant correlation between all four policies and an increased likelihood of mental health treatment facilities offering telehealth services.
The study revealed that mental health facilities located in rural counties demonstrated a higher likelihood of offering telehealth services compared to facilities in urban counties. Furthermore, Community Mental Health Centers exhibited a greater inclination to provide telehealth services compared to other types of facilities.
The study observed a correlation between the proportion of Black residents in a county and a decreased likelihood of mental health facilities offering telehealth services. In comparison to counties with 5% or fewer Black residents, facilities located in counties with over 20% Black residents were found to be 42% less likely to provide telehealth services.
The researchers additionally discovered that mental health facilities that accepted Medicaid and CHIP exhibited a roughly 25% lower likelihood of offering telehealth services. This finding aligns with previous studies that have indicated individuals enrolled in these programs may experience limited access to outpatient care compared to those with private insurance.
McBain emphasized that although state policies have played a crucial role in facilitating the swift expansion of telehealth services in mental health facilities, there is a need for further efforts to tackle disparities and ensure equitable access to care for all groups.
Support for the study was provided by the National Institute of Mental Health.
Other authors of the study are Megan S. Schuler, Nabeel Qureshi, Samantha Matthews, Aaron Kofner, Joshua Breslau and Jonathan H. Cantor.
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
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