A recently published study, “Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness,” was published in the JAMA Health Forum on October 27, 2023, and led by Andrew D. Wilcock. The research team aimed to assess the implications of telehealth use during the COVID-19 pandemic on the quality of care among Medicare beneficiaries diagnosed with serious mental illnesses (SMI), specifically Schizophrenia and Bipolar I Disorder. In particular, this sizeable study sought to compare practice changes with higher vs lower Medicare telehealth use. The study’s sample involved 120,050 participants from March 2019 to February 2021.
- Detailed Analysis. The study looked at various quality metrics beyond just the frequency of attendance for scheduled visits.
- Temporal Comparison. The study also drew comparisons with data from a 2-year pre-pandemic period to isolate the effects of the pandemic and telemedicine utilization.
- Large Sample Size. The extensive cohort bolsters the study’s statistical power and generalizability.
Key Findings: Medicare Telehealth Study
Although this study’s findings were extensive, these main points have been extracted for the reader’s convenience:
- Research Design. The research used a multicohort study design and analyzed data from Medicare telehealth fee-for-service beneficiaries.
- Participants were divided into three groups based on their healthcare providers’ telemedicine adoption rates during the first year of the pandemic: low use (0%-49%), medium use (50%-89%), and high use (90%-100%).
- Multiple outcomes were examined, including the total number of mental health visits, medication adherence rates, and acute care utilization.
- Increased Mental Health Visits. Patients receiving care at practices that predominantly switched to telemental health services showed a 13.0% increase in mental health visits compared to those in practices mainly utilizing in-person visits.
- No Significant Change in Other Metrics. The study found no significant changes in medication adherence, emergency department use, hospitalizations, or mortality rates based on the level of Medicare telehealth utilization.
The findings published by the Wilcox research team highlight that while telehealth facilitated an increase in the frequency of mental health visits for individuals with SMI, it did not substantially alter other measures of healthcare quality, such as medication adherence and acute care usage. This study can be seen as yet another that validates the capability of telehealth to be comparable to in-person mental healthcare delivery for this vulnerable population across practices with higher vs. lower telehealth use.
Most notably, telehealth was shown to improve accessibility. Being the key benefit of telehealth (Maheu & Gordon, 2000; Maheu, Whitten & Allen, 2001) increased access to care at all stages in the trajectory of a disorder, from early to late stage, unlocks many doors for seriously mentally ill people and their families (Maheu et.al., 2004).
Also of note is that SMI includes several additional diagnostic categories, all of which have had empirical support for specified telehealth techniques. Some of these have been addressed by Telehealth.org in these brief summary articles: major depression, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress (PTSD).
Medicare Telehealth Study Summary
The study under discussion presents an in-depth examination of the use and effectiveness of telehealth practices for SMI during the COVID-19 pandemic. Utilizing a national sample, the authors reported that specialty mental health practices that heavily employed Medicare telehealth had higher patient engagement and equivalent outcomes in medication adherence, acute care encounters, and mortality compared to those mainly offering in-person care.
Surprisingly, practices with higher telehealth utilization rates also reported an increase in emergency department (ED) visits and hospitalizations for mental health conditions. While this could be construed as indicative of lesser care quality, the authors of this study posit an alternative view that such increases could also imply more effective crisis management.
Although the study is groundbreaking in scope and scale, it has limitations, including focusing on a specific patient cohort and reliance on claims data, which might not capture all relevant clinical and socio-demographic details. It also leaves questions unanswered about why increased accessibility did not translate into improved medication adherence or reduced acute care usage, which warrants further investigation. These constraints call for a cautious interpretation of the findings.
Overall, the Medicare telehealth study has significant implications for healthcare policy and clinical practices across behavioral healthcare. It supports the continued expansion of telemental health services, particularly among patients with SMIs, while also challenging assumptions about healthcare quality metrics in the telehealth context. The study also underscores the need for further research to explore the nuances and long-term impacts of telehealth adoption, particularly on the cost and benefits for specific client and patient subgroups.
- Maheu, M. M., & Gordon, B. L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31(5), 484–489. https://doi.org/10.1037/0735-7028.31.5.484
- Maheu, M., Whitten, P., & Allen, A. (2001). E-Health, Telehealth, and Telemedicine: a guide to startup and success. Jossey-Bass.
- Maheu, M. M., Pulier, M. L., Wilhelm, F. H., McMenamin, J. P., & Brown-Connolly, N. E. (2004). The mental health professional and the new technologies: A handbook for practice today. Taylor & Francis.
- Wilcock, A. D., Huskamp, H. A., Busch, A. B., Normand, S. L. T., Uscher-Pines, L., Raja, P. V., … & Mehrotra, A. (2023, October). Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness. In JAMA Health Forum (Vol. 4, No. 10, pp. e233648-e233648). American Medical Association.
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