Catalyst for Payment Reform

Enhanced telehealth and behavioral health access: rays of light in the eye of the storm?

Enhanced telehealth and behavioral health access: rays of light in the eye of the storm?

In a prior blog article, we offered perspective on the latest findings from the 2021 Kaiser Family Foundation Employer Health Benefits Survey, noting that employers are in the eye of a hurricane and will have to confront some painful tradeoffs when costs spiral again. But the significant exceptions to employers’ “wait and see approach” to health care benefits during the first year of the COVID-19 pandemic are in the areas of telehealth and behavioral health, including at the intersection of the two.

It will come as no surprise that a sound majority (65%) of employers extended and/or promoted their telehealth programs.  While historically co-pays for telehealth services have been lower than in-person visits, the Survey found that 27% of large employers went so far as to reduce or eliminate cost sharing for telehealth services.  In the past, many employers offered telehealth as a strategy to expand access to primary care and to reduce the use of emergency rooms.  The pandemic moved 35% of the employers surveyed to expand the type of services they offer through telehealth, most notably by including behavioral health care.

Furthermore, virtually every health professional or patient in the United States believes that telehealth is here to stay.  The Kaiser Survey asked employers offering telehealth services how important they felt telehealth would be in providing their employees with access to health care in the coming years. The vast majority of large employers (those with 200 or more employees) felt telehealth would be very important (52%) or important (33%) in providing access.

Many employers also enriched their behavioral health benefits by expanding services and waiving cost-sharing.  Like with telehealth, the goal is to increase access to services in a field notorious for a dearth of supply.  Some of the specific tactics large employers deployed included increasing coverage for out-of-network services (5% of surveyed), expanding the number of mental health or substance abuse providers in their plans’ networks (8%) or waiving or reducing cost-sharing for mental health or substance abuse services (8%).

By making these changes during such a challenging time for employees and the health care system alike, large employers enhanced access to critical services.  It will be important to monitor these trends over the next few years before declaring their permanence.  Of course, there’s the hope that expanded access to telehealth could reduce health care expenditures through early interventions that prevent more expensive downstream utilization.  Unfortunately, the evidence on this is mixed.  It’s also possible that a health care modality that is now easily accessible and even free for some will prompt higher health care expenditures on top of what is already far too costly a health care system.  Employers reacted appropriately to demands for greater access to telehealth and behavioral health services, but the dust still swirls around how they’ll adapt when we pass through this hurricane’s eye and health care costs spiral again.

CPR’s Executive Director, Suzanne Delbanco, PhD, wrote this blog post.

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