Telemedicine Among Medicaid Beneficiaries in Community Mental Health Care during the First Three Months of the 2020 Covid‐19 State of Emergency

RESEARCH OBJECTIVE: Little is known about the effectiveness of telemedicine for patients with serious mental illness (SMI). We sought to identify and describe characteristics of community mental health center (CMHC) SMI patients associated with treatment retention and use of telemedicine during this time. STUDY DESIGN: This research is an observational study of retention in services and use of telemedicine during 12/2019–6/2020 (compared to 12/2018–6/2019) in New Hampshire (NH) CMHC patients. Starting in 3/2020, patients were offered in person and/or telemedicine services based on clinical recommendation and personal choice. NH Medicaid claims provided CMHC service, diagnoses, and demographics. Quarterly use of telemedicine was categorized into <25%, 25–75%, or > 75% of total services. Associations between retention and demographic variables were explored using chi‐square test of independence, logistical regression and correspondence multivariate analysis. POPULATION STUDIED: All 16,030 NH Medicaid beneficiaries with SMI, including debilitating schizophrenia, bipolar disorder, major depression, PTSD, and anxiety/other diagnoses, who were engaged in CMHC treatment during the three months prior to the COVID‐19 State of Emergency (SOE) was declared in NH. PRINCIPAL FINDINGS: 81.7% of patients were retained in treatment in the quarter following the SOE declaration compared to 86.6% of patients in the 2018–2019 period. Comparing 2020 to 2019, youth demonstrated low retention rates (77% compared to 84%, respectively). In 2020, retention among patients with rural zip codes was lower than among those with urban zip codes (78.8% vs 81.2%), and among patients with PTSD (78.1%) and anxiety/ other diagnoses (76.5%) compared to schizophrenia (93.2%) and bipolar disorder (89%). All three multivariate analyses indicate that age, gender, and condition significantly predicted retention. In adjusted models, male gender, age group 18–34, and PTSD diagnosis predicted low retention. In contrast, female gender, age groups 35–54 and 55+, and schizophrenia and bipolar diagnoses predicted high retention. Similar analyses predicting level of telehealth services utilization showed: patients with <25% telehealth services were more likely in the 55+ year age group and schizophrenia diagnosis group; patients with 25% to 75% telehealth services were more likely to be youth and to have PTSD; those with 75% telehealth services were more likely to be in the 18–55 age group, and to have bipolar disorder or major depression. CONCLUSIONS: Telemedicine was utilized by the majority of CMHC patients in the months following the pandemic, likely supporting continuity of CMHC care for vulnerable patients with SMI. Yet, even with this substantial rollout of telemedicine, retention in treatment was less than retention in the prior year, and some sub‐populations were more at risk for treatment interruptions than others. IMPLICATIONS FOR POLICY OR PRACTICE: Telemedicine promoted continuity of care during the pandemic but it is not clear how much telemedicine should continue after the pandemic, and for which subpopulations of people with SMI. Further research on the effectiveness and limitations of telemedicine in patients with SMI is needed to inform future policies and clinical practice.