Impacts of Telehealth Policies on Disparities in Perinatal Behavioral Health Care Access and Outcomes

Rand Corporation, Santa Monica CA

Investigators

Abstract

Project Abstract: Suicide is now the leading cause of death during the perinatal period, and nearly a quarter of maternal deaths are attributable to behavioral health (BH) conditions. As with maternal mortality and morbidity overall, poor perinatal BH outcomes affect different populations to different extents. Despite the prevalence and life-threatening nature of perinatal BH conditions, only 11% of women with these conditions during pregnancy or postpartum receive needed care, and individuals from certain populations are less likely to be screened or treated for BH conditions. Telehealth has enormous potential to address the maternal morbidity and mortality crisis by improving access to perinatal BH care. It has been shown to increase health care receipt and reduce missed appointments for BH care. Research overwhelmingly finds comparable efficacy between in-person and telebehavioral health (TBH) care. Finally, telehealth can help overcome particularly salient challenges for pregnant and postpartum women. Few studies have examined TBH in the perinatal period, but evidence suggests that TBH services for pregnant and postpartum women provide equivalent benefit to those delivered in-person. Importantly, pregnant and postpartum women from certain populations, (e.g., those living in rural areas, those with lower incomes), face additional health care challenges and provider shortages. The extent to which TBH diminishes or amplifies these specific challenges and reduces BH disparities is unknown. Recent policy changes have made telehealth services more widely available. However, state-level Medicaid policies are not uniform, and not all states retained recent expansions in their reimbursement policy. As policies influencing availability of telehealth continue to evolve, quantifying policy impacts on perinatal BH care access and outcomes, and better understanding the mechanisms driving those impacts, are critical to using TBH more effectively to address maternal morbidity and mortality from untreated perinatal BH conditions. To fill these gaps, this mixed-methods study will (1) Develop a detailed, longitudinal dataset describing the evolution of state-level telehealth policies with relevance to perinatal behavioral healthcare for individuals insured by Medicaid; (2) Use event-time modeling to estimate the relationship between telehealth policies of interest and key behavioral health outcomes (e.g., emergency department visits, overdoses, and suicide) and maternal-infant outcomes (e.g., maternal morbidity, preterm delivery), with a focus on identifying disparities among different groups; and (3) Apply the Consolidated Framework for Implementation Research in a series of in-depth interviews with patients and providers to explain the quantitative findings through an examination of factors that influence telehealth policy implementation and associated health outcomes.