Telehealth Availability Is Linked to Better Mental Health Engagement in Those With Medicaid

Telehealth availability at federally qualified health centers was associated with better care engagement for individuals enrolled in Medicaid who had a mental health diagnosis during the COVID-19 pandemic, despite declines in overall visit rates to the health centers, according to the results of a study published on JAMA Network Open.

Investigators included individuals aged 18 to 64 years who were enrolled in Medicaid and had any baseline mental health diagnosis, including anxiety, bipolar disorders, and depression. All individuals were from the Community Care Cooperative in Massachusetts, which is the largest US federally qualified health center-based Medicaid care organization.

Individuals also had 1 or more visits within the past 18 months as of each month, including 1 or more before telehealth expansion.

The primary data were collected between 2019 and 2021 Electronic Data Warehouse from the Community Care Cooperative, including 11 federally qualified health centers, 5 being excluded, because of invalid telehealth data.

The study outcomes included visit rates among individuals with mental health diagnoses of 1 of the 4 most prevalent mental health disorders and having a follow-up visit within 30 days of a mental health-related emergency department (ED) visit. Investigators included federally qualified health centers with a high availability of telehealth during the COVID-19 pandemic, as well as a comparison group with lower availability of telehealth.

The models were adjusted for age, applied study months, clinical risk score, federally qualified health centers fixed affects, sex, and zip code-level digital access.

Investigators included 143,205 individuals per month, with 11,267 who had a mental health diagnosis. They found that visit rates declined across all federally qualified health centers during the pandemic.

However, they also found that high telehealth availability was associated with a larger relative increase in visit rates for individuals with mental health diagnoses, with an incidence rate ratio of 2.07 compared with lower telehealth availability. Additionally, they found comparable results for individuals with specific diagnoses of anxiety, depression, mood disorders, and stress.

Further, the higher telehealth availability was associated with a relative increase of 7.67 percentage points for the likelihood of having a follow-up visit within 30 days of a mental health-related ED visit.

Limitations of the study included having just 1 year of post-telehealth expansion data, potential errors in data reporting, and unmeasured confounding, because of simultaneous implementation of telehealth and other pandemic-related programs.

Investigators also cautioned that the results could potentially be limited to Massachusetts and not generalizable to the entire United States.

The study results suggest that care delivery models supporting telehealth for mental health care could be associated with improved engagement for those enrolled in Medicaid, according to investigators.

The Boston University Institutional Review Board waived informed consent, because only deidentified data were used, and investigators followed the STROBE reporting guideline.

Reference

Cole MB, Lee EK, Davoust M, Carey K, Kim J. Comparison of visit rates before vs after telehealth expansion among patients with mental health diagnoses treated at federally qualified health centers. JAMA Netw Open. 2022;5(11):e2242059. doi:10.1001/jamanetworkopen.2022.42059