Podcast: The Next Generation of Mental Health Policy
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Wednesday, April 6, 2022 | The Latest Research, Commentary, And News
From Health Affairs

Dear John,

Today's newsletter comes from the desk of Jane Zhu, assistant professor
of medicine at the Oregon Health and Science University.

From Jane Zhu

I'm a primary care internist and health services researcher in
Portland, Oregon; a large proportion of my patients have mental health
conditions that I manage along with behavioral health specialists.

During the COVID-19 pandemic, many of my patients with mental health
conditions began scheduling regular telehealth visits to discuss
psychotherapy. I often feel like a virtual mental health provider.

In this month's issue of Health Affairs, my coauthors and I analyzed
more than 100 million outpatient mental health encounters

to compare service utilization before and during the COVID-19 pandemic.
We found that in-person mental health encounters were reduced by half in
the early months of the pandemic, as others have similarly reported for
a variety of health conditions.

But as early as April 2020, outpatient mental health encounter volume
actually started to exceed prepandemic levels, an observation largely
attributable to telehealth uptake.

While telehealth volumes for mental health were negligible in the
preceding study years, nearly half of monthly average mental health
encounters were telehealth visits from March to December 2020.

State lockdowns, temporary regulatory waivers, and expanded
reimbursement for telehealth coverage, among other factors, all
facilitated this massive shift in care delivery.

Policies on telehealth continue to evolve.

Medicare telehealth flexibilities that the Centers for Medicare and
Medicaid Services (CMS) implemented during COVID-19 were extended for
five months in the just-passed FY2022 omnibus spending bill
.

In the 2022 Consolidated Appropriations Act

(CAA), there's a requirement that an in-person service must take place
every 12 months after a telehealth service, rather than within the
6-month window that the 2021 CAA required.

Many states are also reviewing coverage and/or payment parity policies
and have made these permanent.

There are several pieces of legislation winding their way through
Congress.

* The highly anticipated Cures 2.0 Bill
,
introduced in the House in November 2021, includes provisions that aim
to expand telehealth in Medicaid and CHIP and eliminate Medicare's
geographic site restrictions to access telehealth services.

* Last month, Senators Catherine Cortez Masto (D-NV) and Todd Young
(R-IN) introduced the bipartisan Telemedicine Extension and Evaluation
Act to
establish a two-year extension for certain COVID-19 emergency waivers,
expand the list of permissible telehealth providers, and increase the
availability of audio-only telehealth services.

*  The Telehealth Extension Act
,
introduced by members of the House Ways and Means Health Subcommittee in
December 2021, aims to lift geographic and site restrictions to allow
Medicare beneficiaries to access telehealth services regardless of where
they live.

By and large, policy makers at all levels of government have embraced
telehealth, which is set to become a permanent fixture in care delivery
postpandemic.

Given my research interests in mental health, I'm hopeful that
telehealth applications can address some existing gaps in mental health
care delivery.

Even before the pandemic, a robust evidence base supported the use of
telehealth to address gaps in access to mental health care, with high
acceptability and satisfaction
among both providers and
patients.

Mental health care may also be particularly suited to telehealth
modalities, with early research
on
telehealth use among rural Medicare beneficiaries finding that nearly
80% of these visits were for mental health conditions.

Telemental health has been shown to be as effective as in-person care in
diagnostic accuracy, medication and symptom monitoring, treatment
effectiveness, and quality of care, even for those with serious mental
illnesses.

But important questions remain, including how this technology can best
be applied to address different mental health context-and for whom.

An oft-repeated goal of telehealth is to improve access to care,
particularly for those patients who live in areas without sufficient
supply of mental health specialists.

However, disparities in telehealth use grew during the COVID-19
pandemic, with inequitable broadband access disproportionately affecting
rural communities
,
communities of color, and older adults.

Likewise, in our analysis, those with bipolar disorder and schizophrenia
had a lower composition of telehealth encounters as a proportion of
total outpatient encounters compared to people with other mental health
conditions.

While many patients find telehealth to be an acceptable alternative to
in-person care, there are some clinical characteristics for which hybrid
models of care could be more appropriate.

A recent randomized clinical trial
of
patients with posttraumatic stress disorder and bipolar disorder found
that those with sustained in-person outreach at their local clinic were
more likely to remain engaged with psychotherapy than those assigned to
connect solely with a psychologist via video chat.

More evidence is needed, and many experts are working on studying these
clinical questions. But our findings suggest we should view telehealth
as a tool, not as a panacea, for addressing gaps in the mental health
system.

For patients in need of additional support, telehealth may be a useful
complement to in-person care, rather than an alternative mode of care
delivery.

As telemental health models are expanded, flexibilities that account for
clinical context, continued in-person outreach, care continuity, and
patient needs and preferences are warranted.

Something Fun

Apart from clinical care delivery, another thing that has shifted for me
during the COVID-19 pandemic has been my work-life balance. In January I
gave birth to my second pandemic child (my first was born in April 2020,
as the first wave of shutdowns happened).

Between child care, pet care, dinner prep, and laundry, I'm finding
myself a bit frazzled these days.

To decompress and clear my mind, I've started protecting time each day
to step away, walk the dog in the Portland drizzle, and listen to a
rotating array of podcasts.

A few episodes I have enjoyed recently: "This Conversation Will Change
the Way You Think About Thinking
,"
The Ezra Klein Show (if you're in a contemplative mood); "Conan
O'Brien
,"
- Smartless (for some humorous entertainment); and, fittingly, "All
the Help We Can Get
," - HBR
Women At Work.

Elsewhere At Health Affairs

Today in Health Affairs Forefront, Joshua Liao and Amol Navathe explain
how the forthcoming ACO Realizing Equity, Access, and Community Health

(REACH) model makes several advances required for promoting equity
through payment model design.

Zain Rizvi and coauthors discuss how the Biden administration can help
the world learn from and overcome the tragic mistakes of global vaccine
inequality.

HEALTH AFFAIRS BRANDED POST:
The Secret To Healthy Global Economies - More Research And Support For
Women's Health

Hong Chow
Sponsored by EMD Serono

[link removed]

Community Part 2 - The CCBHC One-Stop Shop

How do we translate policy solutions into practice? Avni Kulkarni and
Sania Ali learn about the next generation of mental health policy: the
certified community behavioral health clinic (CCBHC).

Listen Now

Daily Digest

Trends In Outpatient Mental Health Services Use Before And During The
COVID-19 Pandemic

Jane M. Zhu et al.

What Comes Next In Prioritizing Equity In Payment? The ACO REACH Model

Joshua M. Liao and Amol S. Navathe

How President Biden Can Expand Global COVID-19 Test-To-Treat

Zain Rizvi et al.

Podcast: Community Part 2 - The CCBHC One-Stop Shop

Avni Kulkarni and Sania Ali

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mailto:[email protected]

About Health Affairs

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Update .  

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