Telehealth policy expansion's impact on patient care & mental health

University Of California Los Angeles, Los Angeles CA

Investigators

Abstract

Project Summary/Abstract The proposed R01 aims to understand the effect of state telehealth policy changes on patient-reported mental health care and outcomes during the COVID-19 pandemic. The pandemic triggered a 25% increase in depression and anxiety prevalence, with more than 10% of adults unable to receive mental health counseling. Underserved minority populations have been disproportionately impacted, not just in COVID-19 infection and mortality, but also in worsened mental health symptoms, high unemployment, and unmet mental health needs. Mental health care access remains insufficient and fraught with challenges, especially for Medicaid patients. Telehealth can effectively connect patients and providers via electronic platforms that enable video visits, specialist consultation, etc. to bridge gaps in mental health care access widened by COVID-19. Yet, telehealth implementation remains limited for many, but especially in safety-net clinics that serve patients who are often hindered by the digital divide. Telehealth may mitigate or exacerbate health inequities among underserved populations, who may not be able to conduct video visits. Substantial variation exists across states that expanded telehealth policies or not, including Medicaid programs. The pandemic provides an opportunity to naturalistically examine state telehealth policies with potential to improve mental health care and outcomes. Our Specific Aims are to: (1) characterize states’ telehealth policies and identify determinants of telehealth expansion; (2) examine the effects of state telehealth policy expansion during the COVID-19 pandemic on (a) increasing access to, use of, and expenditures related to mental health care and (b) improving mental health outcomes, functioning, and employment; and (3) understand key stakeholder perspectives of how state telehealth policy expansion influenced mental health services delivery during the pandemic, with a focus on improving safety-net care. In Aim 1, we will use legal research to identify state policies that expanded telehealth (e.g., Medicaid reimbursement, private payer laws, professional licensure requirements) and will examine explanatory state factors (e.g., COVID-19 cases, broadband access). In Aim 2, we will leverage variation in telehealth policy across states to use a difference-in-differences approach to predict effects on outcome measures using two nationally representative surveys of individuals – the longitudinal Medical Expenditure Panel Survey (MEPS) and the cross-sectional Household Pulse Survey. Finally in Aim 3, we will use a positive deviance approach to select 6 “high” and 6 “low” telehealth expansion states. From there, we will conduct interviews with 12 primary care and 12 mental health state association leaders and 14 focus groups with clinicians, staff, and administrators in 12 safety-net clinics balanced by clinic rurality. The overall study goal is to better understand the effect of pandemic-related state policy changes around telehealth on patient-reported mental health care access, costs, symptoms, and functioning.