Healthcare without leaving home? Sign me up! That’s the sentiment of more and more people choosing telehealth to connect with providers. This virtual care model, whether via phone, computer, or other connected devices, has fundamentally changed how healthcare outpatient services can be delivered. During the COVID-19 pandemic, telehealth use increased exponentially as the demand for behavioral healthcare surged.
According to an Elevance Health analysis of commercial health plan claims data1, the overall prevalence of behavioral health diagnoses increased by 7% from 2020 to 2021. These findings build on our 2019 to 2020 research, which showed anxiety and major depressive disorder were among the top 5 telehealth diagnoses2. During 2020 to 2021, we found high rates of anxiety, depressive disorder, and trauma and stressor related disorder in younger groups ages 10-25 (Generation Z) and ages 26-41 (millennials), as well as older seniors (born before 1946). Many people seeking care for these and other behavioral health conditions turned to the safety and convenience of virtual appointments during the pandemic, due to restrictions on in-person visits and the need to isolate.
While in-person care has resumed, telehealth use for mental health remains much higher than pre-pandemic levels. The focus now turns to advancing telehealth — including increasing access to technology and internet connectivity, improving affordability and digital health literacy, and reducing inequities to make a lasting impact in behavioral healthcare.
Our Whole-Health Approach
The way we define health is evolving, and this means taking a broader view of the behavioral, social, and physical factors that help people be as healthy as possible and remove barriers to receiving much-needed care. We must take those factors into account for telehealth to have the greatest impact on behavioral health.
Even in the most challenging circumstances, telehealth can open new avenues for holistic care. One of our consumers was diagnosed with a terminal illness, struggling with anxiety, and had no transportation or technology to access the critical care he needed. His case manager and care team through home health provider myNEXUS, an Elevance Health company, stepped in to help. A laptop from his home health agency clinician helped him access both virtual appointments and games to help manage his anxiety. He’s now able to keep medical appointments and has tools to help sustain his mental health.
Advancing telehealth, however, extends beyond securing the required devices to connect. It means supporting and building on efforts that address the need for increased access to high-speed internet connections to use the devices, offering telehealth technical support to people, and improving their digital health literacy — an understanding of how to use a computer, phone, or the internet to find and use health services and information.
Addressing Health Equity
Elevance Health studied telehealth use for behavioral health services pre-pandemic (March-August 2019) compared to during the pandemic (March-August 2020), and our research found stark differences based on members’ race and ethnicity. Among Medicaid members who had existing mental health diagnoses pre-pandemic, Hispanic/Latino members had the highest telehealth use, and Black members had the lowest use.
The research indicates though telehealth is an effective resource to increase access for behavioral healthcare, it does not currently bridge the gap for everyone. “You don't actually solve for equity just by making new technology available,” said Dr. Shantanu Agrawal, chief health officer for Elevance Health. “I believe in order to really address the core inequities we have in American healthcare, we have to be purposeful with how we leverage any new solution, any new technology, and we have to specifically say ‘how will we address equity with this technology?’”
Addressing health equity requires a multi-faceted approach through evidence-based research, robust analytics and program design, and innovative strategies. We must also use cultural humility and caring solutions tailored to understand why barriers to telehealth use exist, and to meet a person’s unique circumstances.
Meeting the Demand
During the pandemic, Elevance Health’s behavioral health services company, Beacon Health Options, saw telehealth use increase by 80 times the levels seen in 2019. By 2025, demand for behavioral health providers is estimated to outpace available resources by 22%. To help address the overall increased demand, we helped train approximately 7,000 providers in virtual care delivery, and we’ve expanded our network of mental health and substance use disorder providers. We’re also providing consumers with virtual behavioral health support and care through our Sydney Health app, where they can set up a video visit with a licensed therapist or board-certified psychologist or psychiatrist.
Elevance Health supports making permanent many of the telehealth policy changes that were enabled during COVID-19, so they remain beyond the public health emergency. These include legislative and regulatory policies that:
- Allow consumers to see doctors or clinicians from their home
- Eliminate in-person visit requirements for those seeking mental health and/or substance use disorder
- Allow telehealth providers to prescribe controlled substances for Medication Assisted Treatment (MAT) specific to treating opioid and SUDs
In addition, Elevance Health supports the Interstate Medical Licensure Compact and other professional compacts that make it easier for practitioners to obtain licenses in multiple states. Elevance Health also champions policy activities that align and advance digital equity, which includes access, affordability, and digital literacy. We support the Infrastructure Investment and Jobs Act (IIJA) Broadband Equity, Access, and Deployment (BEAD) program. This includes historical financial and technical assistance to states for broadband strategy development through the National Telecommunications and Information Association and advancing the Affordable Connectivity Program (ACP) led by the Federal Communication Commission (FCC).
For consumers experiencing behavioral health needs, we’re continuing to create easy access points to get support safely when, where, and how they prefer and are committed to improving equity in telehealth.
1The Elevance Health analysis of Commercial and Medicaid claims data was conducted to review mental health reporting prevalence and trends in the United States in 2021. The claims data was collected by age group and compared among the Gen Z, Millennials, Gen X, Boomers, and Older Seniors age ranges.
2Elevance Health study based on a claims analysis of Medicaid members who had existing mental health diagnoses, including bipolar, major depression and anxiety, and substance use disorder. Members were between 18 and 64 years old with a mental health diagnosis prior to COVID based in at least two medical claims. Members were compared during two six-month study periods: the pre-COVID period from Mar. 1, 2019 to Aug. 31, 2019, and the COVID period from March 1, 2020 to Aug. 31, 2020.