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Patients with high-deductible health insurance plans are less likely to seek out-of-pocket mental health visits, according to a study from Included Health and Harvard Medical School published in the journal JAMA Network Open.
The cohort study included patients from all 50 states and Washington, DC, who were receiving telemental health services from Included Health from two clients—an employer and an insurance plan with varying telemental health coverage—during the study period. Included Health is a nationwide telemental health-only provider.
During the study period, from January 1, 2021, to June 30, 2021, all patients received no cost sharing for telehealth visits. In July 2021, one client reintroduced cost sharing, and the other client—the control group—continued to provide telehealth services without cost sharing.
After re-introduction of cost-sharing, the average number of visits per patient per month was lower in the intervention group than in the control group.
When patients were required to pay out of pocket for telehealth visits, they had significantly fewer telepsychiatric visits, and a larger portion stopped seeing their mental health professional. The authors say these findings suggest that the expiration of the pre-deductible telehealth coverage exception in January 2025 could reduce the use of mental health services, which could lead to worse clinical outcomes.
WHAT IS THE IMPACT?
The dramatic increase in telehealth visits during the COVID-19 pandemic, particularly for mental health, was driven by regulatory changes such as exempting telehealth visits from deductibles in high-deductible health insurance plans — plans where individuals face a minimum deductible of $1,600.
Congress extended this exemption through 2024, and the authors note that there is ongoing debate about whether the exemption should be made permanent.
They determined that their findings were consistent with a body of reliable research showing that patient cost sharing reduces the use of both high- and low-value care.
Given ongoing concerns about access to mental health treatment and to help patients stay in treatment, policies to reduce cost-sharing for both in-person and telehealth mental health visits should be considered, they said, although they did not offer specific policy recommendations.
THE BIGGER TREND
In May, the House Ways and Means Committee passed telehealth legislation to maintain the flexibility for virtual health care offered during the COVID-19 pandemic. The Protecting Access to Telehealth, Hospitals, and Ambulances Act, introduced by Rep. David Schweikert, R-Ariz., and Rep. Mike Thompson, D-Calif., extends Medicare telehealth for two years, home hospital flexibility for five years, and additional Medicare payments for rural hospitals and ambulance services.
The bill proposes to maintain Medicare patients’ access to critical telehealth services for two years and home care services for five years. According to Ways and Means, twenty-five percent of adults reported using telehealth services in the past month, and 78% are likely to complete a medical appointment via telehealth again.
Jeff Lagasse is editor of Healthcare Finance News.
Email: [email protected]
Healthcare Finance News is a publication of HIMSS Media.
