Commercial health insurers should utilize telehealth to address the dearth of pediatric mental health providers, according to a research letter published recently in JAMA Network Open.
Using information supplied by the data aggregating company Castlight Health contained in approximately 1.9 million claims by commercial health insurers, researchers with the RAND Corporation examined in-person and telehealth visits among individuals younger than 19 in three periods: pre-pandemic (Jan. 1, 2019, to March 12, 2020), acute pandemic when COVID-19 vaccines had not yet been available (March 13 to Dec. 17, 2020), and post-pandemic (Dec. 18, 2020, to August 31, 2022).
In-person pediatric mental health visits decline 42% during the acute pandemic phase while telehealth visits for the same period increased 3,027% and overall, there was a 13% increase in mental health visits among children.
In-person visits returned to 75% of the pre-pandemic level by August 2022, while telehealth visits were 2,300% higher than pre-pandemic levels.
“During the post-acute period, we observed a gradual increase in spending rates compared with pre-pandemic for in-person, telehealth, and total visits,” the research letter said. “From January 2019 to August 2022, mental health service utilization increased by 21.7%, while mental health spending rates increased by 26.1%.”
During the timeframe examined—January 2019 to August 2022—mental health utilization increased 21.7% while spending rates rose by 26.1%.
Mariah Kalmin, Ph.D., a RAND health policy researcher and the corresponding author, noted that for kids, most mental health treatment occurs in schools or because of school-based initiatives.
“The increase we saw in mental health service use and spending should, at least in part, be interpreted as a shift from care in schools to care via telehealth for kids stuck at home,” she told Fierce Healthcare in an email. “What is more surprising is that, even two years after the start of the pandemic, telehealth service use remained much higher than before the pandemic.”
That could be because youths liked meeting with therapists online and wanted to continue to do so or, as Kalmin put it, “keep the momentum going.” The apparent growing need for mental healthcare for youngsters represents a challenge for payers. Kalmin said that “for health insurers, bolstering the availability of pediatric mental health care providers through telehealth may be necessary for the foreseeable future.”
Telehealth for children went from being virtually nonexistent pre-pandemic to very prevalent during COVID-19, which should surprise no one given the circumstances.
“What is surprising is the sustainment of telehealth for pediatric mental health care following the initial acute COVID period,” said Kalmin. “Telehealth is clearly here to stay. It will be interesting to see how these trends are sustained in the coming years.”
Kalmin cited extensive previous research showing that telehealth improves access to mental healthcare and, in addition, reduces the rate of no-shows. Telehealth appears to be “relatively effective” in addressing anxiety and depression.
“However, the effectiveness of telehealth at addressing a wide range of developmental needs that kids have is still uncertain,” Kalmin said. “Telehealth is not a substitute for in-person services such as those offered in the school setting.”
In addition, telehealth shifts the time providers care for patients face-to-face to care delivered via phone or video. Kalmin said that “it is partially increasing the total volume of care available, but also shifting how a relatively limited volume of care is delivered.”