Despite an Increase in Telemental Health, Disparities Remain

June 13, 2023 - Pandemic-era flexibilities expanded access to telemental healthcare services, but a new RAND Corporation study, obtained via email, showed that racial health disparities still persisted.

Particularly, the study showed that counties with a high proportion of Black residents and facilities that accepted public insurance did not experience as many benefits.

At the onset of the COVID-19 pandemic, many policies relaxed requirements for using virtual care resources. An example of this included four state-level policies that related to payment parity for all services among private insurers, authorizing audio-only telehealth for patients enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), the Interstate License Exchange Program, and the Psychology Interjurisdictional Compact.

The Interstate License Exchange Program refers to the allowance of psychiatrists to provide care out-of-state. The Psychology Interjurisdictional Compact also refers to out-of-state care but for clinical psychologists.

Researchers aimed to determine whether these policies correlated with telehealth expansion at the start of the public health emergency, particularly within mental health facilities. To do this, they conducted an analysis of information from the Mental Health and Addiction Treatment Tracking Repository. This information covered 12,000 locations, however, researchers focused on outpatient facilities.

The study, which covered April 2019 to September 2022, showed that the share of mental health facilities that used telehealth went from 39 percent to 88 percent. Meanwhile, the number of states with payment parity legislation went from six to 28, while the number of states with audio-only payment policies went from 0 to 33. The number of states that used the Interstate License Program went from 28 to 38, alongside an increase from seven to 32 states using the Psychology Interjurisdictional Compact.

Researchers could conclude that these policies correlated with a higher chance of a mental health facility offering telehealth. However, inconsistencies remained, with the data showing glaring racial health disparities in telemental healthcare utilization.

They noticed that locations in counties with a higher number of Black residents had a lower chance of using telehealth. Specifically, counties with a Black population exceeding 20 percent of the total population had a 42 percent lower chance of using telehealth.

Although this finding is not unprecedented, researchers also noticed that locations accepting Medicaid and CHIP had a 25 percent lower chance of using telehealth. Compared to those of urban counties, mental health facilities in rural counties had a higher chance of using telehealth.

Overall, these findings allowed researchers to establish the large effect that state policies have on telemental health. Furthermore, efforts to limit disparities are needed.

“Our results show that state policies have an important role to play in expanding access to mental health, which could be lost if telehealth policies don’t stay on the books,” said Ryan McBain, lead author of the study and a policy researcher at RAND, a nonprofit research organization, in a press release. “Likewise, disparities need to be addressed with local, targeted legislation.”

Prior research has indicated the prevalence of racial disparities amid the growth of telehealth.

April 2022 research from the University of Houston indicated that Black and Hispanic patients had a lower chance of using telehealth, likely due to the digital divide.

Researchers reviewed over 233,000 visits, 32 percent of which took place through telehealth. When comparing visit types and the users, researchers found that Black and Hispanic people did not use telehealth as much as White people.

They noted that the digital divide likely drove this inconsistency, as certain patients may not have access to technology or the knowledge required for its use.