Patterns of Mental Health Care Before Initiation of Telemental Health Services.

McDowell, Alex; Huskamp, Haiden A; Busch, Alisa B; Mehrotra, Ateev; Rose, Sherri

BACKGROUND Use of telemental health has increased among rural Medicare beneficiaries, particularly among individuals with serious mental illness (SMI). Little is known about what leads to the initiation of telemental health. OBJECTIVE To categorize the different patterns of mental health care use before initiation of telemental health services among individuals with SMI. METHODS A cohort of rural beneficiaries with SMI (defined as schizophrenia/related psychotic disorders or bipolar disorder) with an index telemental health visit in 2010-2017 was built using claims for a 20% random sample of fee-for-service Medicare beneficiaries. The authors used latent class analysis to identify classes of mental health care use in the 6 months before the index telemental health visits. Across the classes, the authors also described characteristics of index and subsequent mental health visits. RESULTS The cohort included 4930 rural Medicare beneficiaries with SMI. Three classes of mental health care use before initiation of telemental health were identified. The largest class (n=3066) had minimal use of primary care provider mental health care and the second largest class (n=1537) had minimal specialty mental health care. The smallest class (n=327) was characterized by recent hospitalization or emergency department care. In the overall cohort, index visits were frequently established visits and were often with specialty prescribers. CONCLUSIONS Our findings highlight 3 distinct patterns of care before telemental health initiation, providing insight into the role that telemedicine may play in mental health care for rural Medicare beneficiaries with SMI. Overall, telemental health was most often used to maintain care with existing providers.