Patterns of Telepsychiatry Usage within Episodes of Mental Health Treatment: Implications for Telehealth Policy
Project Overview
As public and private payers reexamine current telehealth policies, it remains unclear what proportions of patients seen by mental health providers receive care via different treatment delivery modalities. This study will use commercial insurance claims data to determine the proportion of patient episodes of care for mental health treatment conducted entirely via telehealth, entirely in-person, or a combination of the two (hybrid).
Featured Research: Study Reinforces Telehealth’s Vital Role in Expanding Behavioral Health Care Access
A study from researchers with the UNC Behavioral Health Workforce Research Center (BHWRC) showed nearly half of behavioral health care visits in the study timeframe took place virtually, indicating the need for flexible telehealth policies and investments in telehealth infrastructure to expand access. The new findings reinforce telehealth as proven and effective tool for expanding access to behavioral health care.
Nathaniel Sowa, MD, Ph.D., clinical associate professor in the Department of Psychiatry in the UNC School of Medicine and BHWRC collaborator, is lead author of “Modality of Behavioral Health Care Delivery in Commercial Claims: Implications for Telehealth Policy,” which was recently published in Psychiatric Services. “Telehealth is no longer a supplemental modality—it is foundational to behavioral health access,” said Sowa. “Policies that limit its use risk disrupting care for a substantial share of patients who now rely on virtual and hybrid models to initiate and sustain treatment.” A study of more than 937,000 behavioral health episodes of care (EOC) in 2021 and 2022 showed that most of those episodes contained some element of telehealth, with 32.9% being telehealth only and 26% involving a hybrid format. The study is the first to analyze the modality types for behavioral health treatment during the mid–COVID-19 pandemic.
The study showed that female patients used telehealth at a higher rate than males. Women often have more health-seeking behaviors, but virtual care can also reduce logistical barriers that disproportionately impact women, such as transportation or childcare constraints. Patients who lived in urban areas used telehealth more than those in rural areas, which can be limited by structural barriers such as broadband internet access and lower access to electronic devices. The study points to a need for more flexible guidelines to expand access to care for more populations, as well as investment in infrastructure that would bring equitable access to virtual care to underserved areas. For instance, under a January 2026 federal policy, payment for telehealth EOCs would not be allowed without an initial in-person visit per the guidelines of the Centers for Medicare and Medicaid Services.
“With nearly half of episodes of behavioral health care in the study initiated via telehealth, enforcing proposed in-person requirements risks reversing gains in access and continuity achieved during the pandemic era,” said Sowa.