Telehealth Expansion, Telehealth growth

Telehealth Expansion Reportedly Decreased Mental Health Disparities: JAMA Study 2022


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Access to quality mental health care for low-income populations is an ongoing concern. While telehealth expansion efforts during COVID have significantly improved access in many groups; research associated with access to care for low-income mental health populations has been limited.

A November 2022  study published in JAMA Network Open has shown how telehealth expansion in Federally Qualified Health Centers (FQHCs). Study authors Cole and colleagues examined whether telehealth offered at FQHCs relates to visit rates for Medicaid patients with a mental health diagnosis. Primarily using 2019-2021 Electronic Data Warehouse data, the researchers examined 11,267 records of patients between the ages of 18 and 64 years old. 

The study used the following criteria:

  • Patients had to attend at least one mental health appointment within the past 18 months, including at least one visit before the telehealth expansion.
  • Patients were Medicaid beneficiaries with a baseline mental health diagnosis.

Telehealth Growth and Access Data as Measured by Visit Rate

In the Massachusetts FQHCs studied, telemental health care increased from 6% in 2019 to 100% in 2020, when all Massachusetts FQHCs offered mental health services via telehealth. High telehealth availability was related to a larger relative increase in visit rate, despite the decline in visit rates for patients with mental health diagnoses enrolled in Medicaid and served by FQHCs during the COVID-19 pandemic. Telehealth availability was then considered linked to improved care engagement among Medicaid recipients with mental health issues at these FQHCs.

Conclusions: Telehealth Expansion & Heath Disparities

This JAMA Network Open study identified differences in the adoption of telehealth to provide remote mental health care to Medicaid beneficiaries. During COVID-19, the study revealed lower visit rates across all FQHCs. 

  • After widespread telehealth adoption, there was a greater relative increase (7.67 percentage points) in the visit rates of patients diagnosed with mental health concerns. 
  • This increase in visits was associated with an increased likelihood of patients participating in a 30-day follow-up visit following a mental health-related emergency department visit when telehealth availability was high. 
  • Data from patients with different diagnoses yielded similar results.

Other research in support of these findings (e.g., Harju & Neufeld, 2021; Uscher-Pines et al., 2019) has suggested that care delivery models that promote telehealth growth in mental health may be related to better engagement with Medicaid patients.

This study’s described limitations include the following:

  • Limited data using only one year of post-COVID telehealth expansion data
  • Limited generalizability beyond Massachusetts
  • Potential errors in data reporting.
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