Mental Health Utility, Spending Significantly Increased Among Commercially Insured Adults

Jonathan H. Cantor, PhD

Credit: LinkedIn

Mental health care service use increased approximately 40% among commercially-insured adults since 2019, according to new data that elucidates the substantial expansion of telehealth in psychiatry during the COVID-19 pandemic.¹

A team of US-based investigators have reported that both utility and spending rates for mental health care disproportionately increased from just 2019 – 22—a trend that which they believe will again significantly alter with the conclusion of the public health emergency declaration for the COVID-19 pandemic.

Mental health condition-based telehealth services were at a boom from the onset of the COVID-19 pandemic, as policies rapidly adopted remote care options and services for persons adapting to stay-at-home mandates and office/public space closures. The Centers for Medicare & Medicaid Services broadened its access to consumer telehealth services as an extension of the public health emergency declaration in early March 2020, and infrastructure for telemedicine billing was shortly thereafter structured for private payers to adopt.²

Led by Jonathan H. Cantor, PhD, of the RAND Corporation in Santa Monica, investigators sought to assess the rates of monthly telehealth versus in-person utility and spending for mental health services among commercially-insured adults in the US from 2019 – 2022.

“Three years after the 2020 SARS-CoV-2 national public health emergency declaration, many facets of the US health care system have returned to normal,” they wrote. “However, trends in mental health service utilization and spending before expiration of the public health emergency in May 2023 are largely undocumented.”

Cantor and colleagues conducted a cohort analysis of the quantified trends in mental health service utilization and spending in eras representing the pre-public health emergency (January 1, 2019 – March 12, 2020), the pre-vaccine phase of the public health emergency (March 13, 2020 – December 17, 2020), and the post-acute phase (December 18, 2020 – August 31, 2022). Trends were defined as monthly medical claims per 1000 beneficiaries and spending per 10,000 beneficiaries among approximately 7 million commercially-insured adults.

Relevant conditions followed ICD-10 diagnosis codes for anxiety disorders, major depressive disorder, bipolar disorder, schizophrenia, and posttraumatic stress disorder (PTSD).

Their final analysis included more than 1.55 million mental health service claims. In the acute phase, the rate of in-person visits decreased by 39.5%, while telehealth visits increased more than 10-fold (1019.3%) compared to the prior year (P <.01). Overall utilization of both in-person and virtual telehealth for psychiatric care had increased 22.3%.

During the post-acute era, telehealth visits remained at 1068.3% greater rates than pre-pandemic averages; in-person visits increased just 2.2% each month over the period (P = .02). In-person visit rates reached approximately 80% of their pre-pandemic levels by August 2022, while overall psychiatric care was 38.8% greater than pre-pandemic levels.

Regarding spending rates, acute phase-era per capita expenditures increased 29.5% year over year (P <.001). Spending rates gradually increased in the post-acute era. The average spending rate of $3,547,424 per 10,000 beneficiaries in the post-acute era was a 53.7% increase versus the pre-pandemic era average of $2,308,247 per 10,000.

Cantor and colleagues noted the volatile increases in mental health care spending will again likely change due to the conclusion of the public health emergency this year, “with insurers either continuing or stopping coverage for telehealth visits for mental health services.”

Though the research was limited by the narrow focus of commercially-insured adults as well as the inability to distinguish new patients from existing ones, the investigators concluded their findings show a persistent elevation to mental telehealth service utilization in the US.

“If this increased utilization affects spending, insurers may begin rejecting the new status quo,” they wrote. “This concern is particularly relevant when considered against the backdrop of telehealth policies that expired alongside the national public health emergency declaration.”

References

1. ^{Cantor JH, McBain RK, Ho P, Bravata DM, Whaley C. Telehealth and In-Person Mental Health Service Utilization and Spending, 2019 to 2022. JAMA Health Forum. 2023;4(8):e232645. doi:10.1001/jamahealthforum.2023.2645}
2. ^{Kunzmann K. When Telemedicine Began in the US. HCPLive. Published June 22, 2020. https://www.hcplive.com/view/when-telemedicine-began-in-the-us}