Patients are less likely to seek virtual behavioral care if they pay out of pocket

Patients with high-deductible health plans are less likely to request a telehealth consultation if they have to pay the costs themselves, according to a study from Included Health and Harvard Medical School published in JAMA Network Opened.

The cohort study included patients from all 50 states and Washington, DC, who received telemental health care from Included Health from two clients – one employer and one insurance plan that varied in their coverage of telemental health care during the study period. Included Health is a national company that offers only telehealth.

During the study period, January 1, 2021 to June 30, 2021, all patients had no cost sharing for telehealth visits. In July 2021, one client reintroduced cost sharing and the other client—the control—continued to provide telehealth services without cost sharing.

After the reintroduction of cost sharing, the average number of visits per patient per month in the intervention group was lower than in the control group.

When patients had to pay for telehealth visits themselves, they had significantly fewer telehealth visits and a greater proportion stopped seeing their mental health specialists. Authors said the findings imply that the expiration of the exemption for predeductible telehealth coverage in January 2025 could reduce the use of mental health services, potentially leading to worse clinical outcomes.

WHAT IS THE IMPACT?

The surge in telehealth visits during the COVID-19 pandemic, particularly for mental health, was amplified by legislative changes such as the exemption of telehealth visits from the deductible in high-deductible health plans — plans where individuals have a minimum out-of-pocket cost of $1,600.

Congress extended this exemption through the end of 2024, and the authors noted that there is still debate over whether the exemption should be made permanent.

They concluded that their findings are consistent with a large body of research showing that patient self-pay leads to a decrease in both high-quality and low-quality care.

Given ongoing concerns about access to mental health care and helping patients stay in treatment, policies that reduce cost-sharing for both in-person and telepsychology consultations should be considered, the researchers said. However, they did not make specific policy recommendations.

THE BIGGER TREND

In May, the House and Manners Committee has passed telehealth legislation to preserve flexibility for virtual care introduced during the COVID-19 pandemic. The Preserving Telehealth, Hospital, and Ambulance Access Act, introduced by Reps. David Schweikert, R-Ariz., and Rep. Mike Thompson, D-Calif., would extend Medicare telehealth coverage for two years, hospital-at-home flexibility for five years, and supplemental Medicare payments for rural hospitals and ambulance services.

The bill proposes giving Medicare patients access to essential telehealth services for two years and home-based hospital services for five years. Twenty-five percent of adults report using telehealth in the past month, and 78 percent are likely to complete another medical appointment via telehealth, according to Ways and Means.

Jeff Lagasse is editor of Healthcare Finance News.
Email address: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.