The requirement to pay out-of-pocket significantly affects patients’ engagement in virtual behavioral care, specifically telemental health visits, under high-deductible health plans. A recent study by Included Health and Harvard Medical School, published in JAMA Network Open, has revealed that patients are less inclined to seek telemental health services when they have to bear the costs themselves. This finding is crucial in understanding the dynamics of mental health care access amid changing healthcare policies and the evolving landscape of telehealth services post-pandemic.
Study Overview and Findings
Initial Cost-Free Period
The investigation included patients from all 50 states and Washington, D.C., who received telemental healthcare from Included Health. The study spanned from January 1, 2021, to June 30, 2021, during which all participants had no cost-sharing for telehealth visits. This period coincided with regulatory changes that encouraged widespread adoption of telehealth services by exempting such visits from deductibles in high-deductible health plans. This measure, enacted during the COVID-19 pandemic, aimed to facilitate access to essential health services while minimizing the risk of virus transmission.
However, the landscape shifted in July 2021, when one of the employers involved in the study reintroduced cost-sharing for their employees, while the other continued offering free telehealth services, effectively serving as the control group. The reintroduction of cost-sharing served as a pivotal variable in assessing the impact of out-of-pocket costs on patient behavior. The results were clear: the average number of monthly visits per patient decreased in the cost-sharing group compared to the control group, highlighting the deterrent effect of financial barriers.
Decline in Visits and Patient Discontinuation
When patients had to pay out-of-pocket, there was a marked decline in the number of telemental health visits, alongside an increase in the number of patients who discontinued their visits. This trend is concerning, as it suggests that financial constraints may lead to reduced access to necessary mental health services, potentially exacerbating existing mental health issues. The study’s authors pointed out that ending the pre-deductible telehealth coverage exemption in January 2025 could lead to further reductions in mental health service use and potentially poorer clinical outcomes.
These findings align with existing research indicating that patient cost-sharing generally reduces both essential and non-essential care usage. As mental health disorders require continuity of care, interruptions in treatment can lead to adverse outcomes, including the worsening of symptoms and reduced overall well-being. The study underscores the need to consider policies that mitigate financial barriers to accessing care, particularly for mental health services, where timely and consistent intervention is crucial.
Legislative Efforts and Implications
Preserving Telehealth Flexibility
The rise in telehealth visits during the COVID-19 pandemic was supported not only by technological advancements but also by regulatory changes. Lawmakers are currently debating whether the exemptions for telehealth visits in high-deductible plans should become permanent, with the current exemption extended through 2024. Legislative actions aimed at preserving telehealth flexibility are gaining traction. For example, the House Ways and Means Committee passed the Preserving Telehealth, Hospital, and Ambulance Access Act, extending Medicare telehealth access for two years and hospital-at-home services for five years.
This legislative effort reflects continued public demand for telehealth services, as evidenced by surveys indicating that 78% of adults are likely to use such services again. The pandemic has undeniably accelerated the adoption of telehealth, making it an integral part of the healthcare system. Therefore, policies that ensure the sustainability and accessibility of these services are essential for meeting the ongoing needs of the population.
Impact on Mental Health Services
The necessity for patients to cover costs out-of-pocket greatly impacts their participation in virtual behavioral health care, particularly telemental health visits, when they are enrolled in high-deductible health plans. A study conducted by Included Health and Harvard Medical School and published in JAMA Network Open shows that patients are less likely to pursue telemental health services when they have to pay for them themselves. This research highlights a significant barrier to accessing mental health care in the context of shifting healthcare policies and the rapidly developing telehealth sector, especially in the aftermath of the pandemic. As telehealth services gain popularity and become more integrated into standard health care practices, understanding financial barriers is essential. High-deductible plans inherently burden patients, making them hesitant to seek necessary mental health treatment due to cost concerns. Therefore, addressing these financial challenges is important for improving patient engagement and ensuring equitable access to mental health services.
