Background: COVID-19 has driven a need for mental health services and increased telehealth utilization. These trends have affected populations differently. The CDC reports that racial and ethnic minorities, essential workers, and unpaid adult caregivers have experienced disproportionately worse mental health outcomes during the pandemic. Other studies detail disparate utilization of telehealth services by some of these groups. Despite clear evidence of telehealth’s clinical benefits in specific situations, less is known about how to provide telehealth to reduce utilization disparities. As AHRQ has observed, more research is needed on the effectiveness of telehealth, which was rapidly expanded during the pandemic. Dialogue among Medicaid patients, providers, and payers to examine existing research and share their own experiences can uniquely clarify how telehealth is being used and reveal knowledge gaps to inform research designs that assess patient-centered outcomes of telehealth expansion for mental health.
Proposed Solution to the Problem: NEHI proposes to convene patients, providers, and insurers involved in Medicaid to develop consensus recommendations on patient-centered outcomes research/comparative clinical effectiveness research (PCOR/CER) that target effective, equitable access to and use of remote care to treat mental health conditions given telehealth's rapid expansion and potential to meet growing needs. A Medicaid focus is warranted; Medicaid provides access to mental health care for those disproportionately affected by the pandemic, including a large portion of minorities. NEHI will conduct the convening to ensure meaningful discussion. In focus groups of ~10 individuals (step 1), NEHI will facilitate discussion of perspectives on PCORI and other studies that have examined tele-mental health. In a convening including all participants (step 2), NEHI will elicit stakeholder experiences from telehealth expansion. Collective reflection on focus group assessments of existing research against shared experiences is intended to enable consideration of areas in which further study is needed.
Objectives: NEHI aims to provide consensus recommendations on next-generation PCOR/CER questions to address disparities and other issues in the use of remote mental health care, especially with respect to modalities newly available in the pandemic. NEHI’s final report will identify research priorities endorsed by parties with strong stakes in patient-centered outcomes. The project team will highlight different stakeholders' perspectives on current tele-mental health research. Consensus on existing research may underline the need for further dissemination to reduce access disparities. The effect of facilitated discussion of stakeholders' perspectives on current tele-mental health research findings and shared experiences with tele-mental health can contribute practical engagement strategies for patients and other stakeholders in identifying research questions involving mental health and/or vulnerable populations.The project's long-term objective is to foster effective innovation in tele-mental health care.
Activities: The team plans to recruit 30 participants (~15 racially diverse Medicaid patients; insurers and clinicians equally composing the balance). NEHI will provide a review of studies focused on engagement of individuals in tele-mental health services during the pandemic (relevant studies funded by PCORI, published studies in academic and trade journals, and patient surveys and utilization analyses conducted by convening participants). To obtain feedback on priority issues and research reviews, the team will hold approximately five multi-sector stakeholder focus groups (remote +/or in-person). For the convening, the team will develop an agenda incorporating focus group sessions. In planning the convening, the team will consult with researchers whose studies have been referenced in the focus groups and others referred to the team as having a strong interest/background in this area. The team will determine how to best involve a small number of researchers in all or part of the convening.
Part 1 of the convening will identify consensus on impactful findings for dissemination. Part 2 will elaborate areas that require further study (differences in interpretations of current work, emerging trends in access and treatment, or unresolved issues of value and cost-effectiveness). A final report will describe the project process and outcomes.
Projected Outcomes and Outputs:
- Short term: Shared understanding of multi-stakeholder perspectives on existing research, including awareness of relevant research among Medicaid patients, Medicaid payers (managed care and FFS), and clinicians serving Medicaid patients. Identification of concordant and disparate interests in further information about telehealth utilization for mental health to inform research. Recommendations for enhanced dissemination of impactful research.
- Medium term: Recommendations on PCOR/CER projects for effective and equitable expansion of tele-mental health based on a framework of shared priorities (e.g., primary care involvement; mobile access; medication management; expanded quality metrics).
- Long term: Replication of the convening methodology to inform PCOR/CER on tele-mental health access in Medicare and commercial populations; insights into engagement processes that are relevant to involving vulnerable populations in research design.
Patient and Stakeholder Engagement Plan:
Convenings that elicit multiple stakeholder perspectives around innovations in care are a standard feature of NEHI projects. NEHI draws on its multi-sector membership and relevant stakeholder groups to create balanced discussions reflecting divergent views. In formulating this proposal, NEHI engaged with mental and behavioral health service organizations, patient organizations, state Medicaid officials and the National Medicaid Association, insurance plan representatives, and clinicians. We discussed questions they found most pressing in relation to the increased use of digital technologies to address mental and behavioral health needs and the format proposed for this convening. NEHI has secured commitments from most of those with whom it spoke to either participate in the project directly, assist in identifying patients, or provide consultation in connection with it. Moreover, NEHI will engage stakeholders during the project to consult on the structure of the all-participant convening.
Project Collaborators: N/A
Wendy Warring, BA, JD
Network for Excellence in Health Innovation (NEHI)
Last updated: March 4, 2022