Modality of Behavioral Health Care Delivery in Commercial Claims: Implications for Telehealth Policy

OBJECTIVE: The authors examined the distribution of behavioral health episodes of care (EOCs) by modality-telehealth only, in-person only, and both (hybrid)-to identify factors associated with telehealth use. METHODS: Using 2021-2022 MarketScan Commercial Database claims, the authors categorized EOCs by modality. Descriptive analyses were followed by logistic regression to identify independent associations of patient and provider characteristics with telehealth use. RESULTS: Among 937,711 EOCs, 41.1% were in-person only, 32.9% telehealth only, and 26.0% hybrid. Compared with individuals <18 years, all adult age groups had higher odds of telehealth-only care. Female sex and urban residence were also associated with greater telehealth use, whereas residence outside the Northeast and nonpsychiatrist providers were associated with lower use. Among hybrid EOCs, telehealth initiation was more likely among adults ages 36-55, urban residents, and those treated by nonpsychiatrists. CONCLUSIONS: Telehealth constituted a substantial proportion of behavioral health care, highlighting the importance of maintaining flexible telehealth policies.