While telehealth helped bridged some gaps, Anthem’s State of the Nation’s Mental Health data showed significant differences continued among communities of color
The Hispanic/Latino community was the most engaged in telehealth for mental health visits in 2020 – adopting the technology more than any other ethnic or racial group, according to a new analysis of Medicaid members in 14 states as part of an Anthem, Inc. State of the Nation’s Mental Health special report during National Minority Mental Health Awareness Month.
Telehealth served as a silver lining during the pandemic and a strong alternative to seeing clinicians and counselors in person. Telehealth visits – either via video or phone — for people with an existing mental health condition significantly increased during the height of the pandemic. Visits that started in the single digits before COVID-19 accounted for 49 percent of all Medicaid mental health visits during a six-month period in 2020. Telehealth regulations lifted during COVID-19 have assisted in removing barriers people may have experienced in accessing telehealth.
Overall gaps in getting mental health care between races and ethnic groups remained essentially the same before and during COVID. A higher percentage of Hispanic-Latinos were already receiving in-person or telehealth mental health visits before COVID-19. By greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions – especially with Hispanics/Latinos. In fact, during COVID-19, almost 40 percent of Hispanic/Latino members had a telehealth visit, while White members had 34 percent, Asian members had 33 percent and Black members had 28 percent.
While telehealth did boost visits during COVID-19, it didn’t make up for the dramatic drop in in-person visits for all races and ethnic groups. And there were significant differences among them. In fact, Black people had the lowest percent of combined telehealth and in-person visits – 56 percent – before COVID-19 and remained the lowest with 49 percent after COVID-19.
On average, Black people had 7 percent fewer mental health visits compared to White people with similar demographic, clinical and socio-economic backgrounds. The rates are particularly noteworthy as surveys have indicated that people of color were experiencing more stress and mental health conditions than other populations in 2020 and people of color were disproportionately impacted by COVID-19.
“There are likely many reasons behind the differences in mental health care visits – including issues that prevent people from seeking care, such as medical injustices and a history of receiving culturally insensitive care,” said Anthem Chief Health Officer, Shantanu Agrawal, MD. “Health equity is a key driver for mental and physical well-being. To achieve equity in our healthcare, we need to understand where and why barriers to health exist, and then couple these insights with the scale and scope of Anthem to drive changes to a new system of health, that puts equity at the center.”
Historically, major depression and anxiety are underdiagnosed at rates of 32-40 percent less in Black and Hispanic/Latino communities, according to the BCBS Health Index. The American Psychological Association says that lower diagnosis rates are likely driven by lack of provider understanding of cultural differences, stigma around diagnosis or treatment and barriers getting care.
For Medicaid members with an existing mental health diagnosis, the most common telehealth diagnoses were anxiety, depression and bipolar disorder, according to the special State of the Nation’s Mental Health report. High blood pressure was among the top five diagnoses for Black, Asian and Hispanic/Latino people, while high cholesterol was a top five medical diagnosis for Hispanic/Latino and Asian people. Opioid use disorder was one of the top five diagnoses for White people, while severe back pain was a top diagnosis for Black people. These data reinforce that mental health and physical health are connected and improving one can help the other.
“While telehealth wasn’t a panacea in eliminating health equity gaps, it helped boost connectivity for all and made Internet visits possible when COVID temporarily closed physical doors, allowing health care to continue to be delivered with some semblance of normalcy,” Agrawal said. “This study is a key reminder that technology alone won’t be sufficient to bridge this gap and the bridge may not be the same for all people. However, it may be the connector needed by certain communities or geographic areas. Clearly, outcomes during the pandemic would have been much worse without telehealth.”
Interestingly, members used telehealth and in-person mental health services similarly whether they lived in an urban or rural area.
Anthem will continue to evolve the following efforts to ensure that it can bridge the gaps for all people that take into consideration their specific needs. Some of these efforts include:
- Social drivers of health benefits that can assist in improving health equity for physical and mental health.
- Peer programs, such as those offered by Anthem and Beacon, may also help create trust by pairing members with someone who has the same lived experience.
- Education and informative efforts that involve connections to trusted sources, like churches and even barbershops, have been shown to have greater impact on community acceptance of health services.
- Continuing Medical Education programs, such as www.mydiversepatients.com, that train clinicians about bias and cultures different from their own, and go a long way in creating stronger, more trusting and culturally responsive relationships between clinicians and patients.
Anthem supports making permanent many of the telehealth policy changes that have occurred during COVID beyond the public health emergency. These include legislative and regulatory policies that:
- Allow consumers to see doctors or clinicians from their home.
- Allow providers with appropriate medical licensure to deliver services across state lines, and
- Eliminate pre-COVID-19 policies that placed prohibitions on prescribing medications via telehealth.
About the study
The study is based on a claims analysis of Medicaid members who had existing mental health diagnoses, including bipolar, major depression and anxiety, and substance use disorder. Mental health visits are defined as office visits for evaluation and management of mental health conditions through either telehealth, inclusive of video or phone, or in-person.
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. Data was adjusted for age, gender, socio-economic status, rurality, state of residence, Elixhauser comorbidity index score, prior health conditions and healthcare utilization.
Anthem is a leading health benefits company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves more than 116 million people, including more than 43 million within its family of health plans. We aim to be the most innovative, valuable and inclusive partner. For more information, please visit www.antheminc.com or follow @AnthemInc on Twitter.
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