Trends In Outpatient Mental Health Services Use Before And During The COVID-19 Pandemic.

The COVID-19 pandemic disrupted mental health services delivery across the US, but the extent and implications of these disruptions are unclear. This retrospective observational analysis used the claims clearinghouse Office Ally to compare outpatient mental health services use from March to December 2016-18 against use during the same period in 2020. We identified encounters for people ages twelve and older with primary diagnosis codes corresponding to mental health conditions and categorized encounters as in-person or telehealth, using Current Procedural Terminology and place-of-service codes. In-person mental health encounters were reduced by half in the early months of the pandemic, with rapid recovery of service delivery attributable to telehealth uptake (accounting for 47.9 percent of average monthly encounters). We found variation in the degree to which telehealth use increased across groups: People with schizophrenia made up a lower proportion of telehealth encounters relative to in-person visits (1.7 percent versus 2.7 percent), whereas those with anxiety and fear-related disorders accounted for a higher proportion (27.5 percent versus 25.5 percent). These findings highlight the importance of broadening access to services through new modalities without supplanting necessary in-person care for certain groups.

Washington's Medicaid Transformation Project: Engaging the health care and social service sectors to improve health care delivery and address the social determinants of health.

Across the US, states have initiated reforms to improve population health by coordinating efforts among health care stakeholders and addressing health-related social needs. Washington State's Medicaid Transformation Project (MTP), launched in 2017, seeks to achieve these goals by supporting the state's Accountable Communities of Health, independent organizations that convene and coordinate the health care and social service sectors in nine regions of the state. MTP places Medicaid funds in the hands of ACHs for the purpose of building health system capacity and carrying out health improvement projects. It includes new supports for aging, housing and employment, and substance use disorder treatment. Early lessons from MTP are emerging that can inform health system transformation efforts in other states. MTP demonstrates the advantages of creating new organizations to serve as regional conveners and coordinators. However, the introduction of new entities will require states to clearly articulate the varying roles of these entities and existing managed care organizations and state agencies. States will need to balance the tradeoffs of local control versus centralization. For example, it may be optimal to standardize electronic health information exchanges but allow organizations flexibility to adopt other interventions that match their local context. In addition, states should build treatment and comparison groups into their program designs in order to generate high-quality evidence about the impact of new health care delivery and payment models.