Outpatient behavioral health visits rise due to greater telehealth use

Outpatient telehealth visits for behavioral health issues saw a massive increase during the height of the COVID-19 pandemic, largely due to eased restrictions on its use, a new report shows.

Insurance company UnitedHealth Group used data from its subsidiary Optum Behavioral Health to measure trends in in-network, outpatient behavioral health visits from 2019—the year before the pandemic-- through the second quarter of 2021. It found a 5,700% increase in telehealth visits during the period, more than offsetting a 55% decrease in office-based visits. The total number of visits grew by 26% during the period.

The biggest jump in telehealth visits as a percentage of all visits occurred between the end of 2019, when they were virtually nonexistent, and the second quarter of 2020, by which time they accounted for 74% of them. The percentage then gradually declined to 65% by the end of the period.

“Prior to the COVID pandemic, telehealth was broadly viewed as a potential strategy for improving access to behavioral health care,” the report says. “During the pandemic— which saw increased rates of depression, anxiety, and substance use disorder—federal and state policymakers and commercial health plans established temporary flexibilities to increase access to care, and patients and providers increased their use of virtual visits as an alternative to in-person office-based care.”

Measured by type of provider, the largest increase in visits—46%--occurred among counselors and therapists. That was followed by clinical social workers (30%), psychiatrists (10%), psychologists (9%), and psychiatric nurse practitioners (4%).

The report notes that telehealth, combined with greater flexibility in clinician licensing rules at the start of the pandemic, lessened the need for geographic proximity between patients and providers. From 2019 to 2020 there was a 32% increase in visits among patients and providers located in different states, and a 22% increase where patients and providers were in different counties in the same state.

The report cites three benefits of telehealth that may have contributed to the rise in its use as well as behavioral health visits overall:

• Clinical effectiveness, which can be equal to or greater than office-based care;
• Increased provider capacity due to reducing barriers to care resulting from provider availability and location and reduced patient no-show rates; and
• Improved access to care by enabling patients to see providers in other states, to get treatment without missing work or incurring travel time and costs, and being able to receive care in a comfortable, private, and convenient location

The report notes that making the flexibilities introduced at the start of the pandemic permanent would improve access to behavioral care for both patients with commercial insurance and those covered by Medicare and Medicaid. But better access would also require addressing disparities in access to broadband, improved digital literacy and increasing the number of behavioral health providers.