Telehealth Use for Mental Health Conditions Among Enrollees in Commercial Insurance

Telehealth use grew rapidly during the first wave of the COVID-19 pandemic in the United States, but the extent to which it will persist after the pandemic is unclear (1, 2). We examined trends in the patterns of telehealth use for mental health conditions from January to June 2020.

We identified telehealth services in a national data set of commercial enrollees from FAIR Health, a nonprofit organization managing a database of >33 billion privately billed health insurance claims, submitted by >60 payers. We calculated telehealth use rates as a percentage of all mental health services by condition category by using the outpatient and inpatient claims for both telehealth and in-person services as a common denominator, which represented roughly 25 million unique claim-level procedures. The telehealth use rate for mental health conditions increased from 2.2% in January 2020 to 65.2% in April 2020, remaining stable at 65.6% in June 2020 (Table 1). Services for generalized anxiety disorder made up the largest share of mental health telehealth services (28.4%), followed by major depressive disorder (23.6%), and adjustment disorder (18.6%).

In June 2020, telehealth use rates for mental health conditions were 67.1% among females and 62.4% among males and ranged from 59.6% for those ages ≥65 years to 70.1% for those ages 25–34 (Table 1). Moreover, 49.6% and 66.8% of all mental health services were via telehealth for patients in rural and urban areas, respectively. From April to June 2020, differences in telehealth rates between rural and urban areas grew from 5.1 to 17.2 percentage points, as telehealth use decreased among rural patients.

As COVID-19 shelter-in-place measures were relaxed across the United States, telehealth use for mental health conditions continued to account for nearly two-thirds of mental health services, while telehealth rates decreased 16.2 percentage points from April to June 2020 for services for acute respiratory diseases and infections, the service category with the next-highest telehealth use rate. This may have been due in part to other clinical conditions more frequently requiring general medical examinations for diagnostic purposes, as well as recent surges in direct-to-consumer mental health startups (3).

Telehealth-based mental health services increased overall, but future work might examine why uptake was lower in rural areas and among older individuals and how broadband infrastructure and digital literacy may affect telehealth use (4). As mental health digital interventions continue to proliferate, new evidence on the cost-effectiveness of telehealth may determine whether mental health services will still primarily be delivered remotely (5).