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COVID-19 ratcheting up demand for virtual behavioral healthcare, Cigna finds

The use of telehealth for behavioral health services increased more so than for any other type of healthcare during the pandemic.

Jeff Lagasse, Associate Editor

(Photo by Aekkarak Thongjiew/EyeEm/Getty Images)(Photo by Aekkarak Thongjiew/EyeEm/Getty Images)

The COVID-19 pandemic is increasing the demand for telehealth, driving consumers to increasingly seek virtual care options, and this is extending to behavioral health services, according to a new report from health insurer Cigna.

Part of the uptick in demand for virtual behavioral health is attributable to a general rise in the pursuit of mental healthcare services, the data showed, with a 27% increase in behavioral health outpatient care compared to pre-pandemic levels.

Sixty-three percent of all behavioral patients were female (vs. 48% pre-COVID-19), with women seeking care at higher rates than men across all age and ethnic groups, while 45% of those seeking behavioral care were under 30. About 18% were under age 18 – an 18% increase from before the pandemic – and 27% were aged 18-29, a 33% increase.


In all, 44% of human resources decision-makers and 27% of health plan leaders said that increased access to mental health services will become a long-term solution for their organization. Some 57% of health plan leaders said they had seen the value of mental health services increase more than for most other services and benefits as a result of the coronavirus.

Telehealth is likely the main catalyst for this change, with many patients seeking behavioral care for the first time during the public health crisis thanks in large part to access to technology.

With over 60% of behavioral health customers now using virtual services, 97% of the people who accessed such services during the initial stay-at-home orders from March to May 2020 didn't have a behavioral telehealth claim prior to lockdown.

While more female adult patients used behavioral health care overall, males over the age of 18 adopted virtual behavioral healthcare at higher rates, data showed.

The one potentially problematic finding related to this increased usage is a sustained increase in the use of prescription medications for depression and anxiety, with a 7.9% increase in the use of antidepressant medications in 2020 vs. 2019.

In addition, more than 32% of those taking antidepressants in 2020 had no history of use six months prior to their first prescription fill date.

Overall, though, Cigna's data found that virtual behavioral health services are making a positive impact in the workplace. Almost half of behavioral telehealth users reported higher productivity at work, and many reported taking fewer sick days.

Telehealth usage in general is on the rise. Before the pandemic, virtual visits made up just over 1% of all medical and behavioral professional office visits that could be conducted virtually. Today, they make up nearly 25%.

Primary care and behavioral services were the largest specialties utilized virtually in 2020: More than one-fifth of primary care was performed virtually, and nearly two-thirds of behavioral care was performed virtually.

More than half of Americans are comfortable with virtual consultations replacing in-person visits, especially if it was more convenient (47%), decreased costs (44%), allowed for free virtual follow-ups (37%), and allowed for long-distance care (35%).

However, telehealth isn't replacing all in-person services. Pediatric care, for example, was still largely performed in person, with just 12.9% of pediatric care visits performed virtually.


A recent study showed that mental health services accounted for the most common use of telehealth during the early days of the pandemic. In the midst of skyrocketing depression rates, the findings show that more patients used telehealth for behavioral rather than physical conditions.

This shift to telehealth, particularly video, was enabled by time-limited, regulatory changes related to reimbursement, privacy standards for telehealth technology, and licensure. Lessons from utilization during this period can inform policy for the post-COVID-19 era.

Importantly, measures will be needed to ensure equity of access, particularly for behavioral healthcare as education, age and gender were all associated with use. Lack of health insurance may also affect telehealth use.

Healthcare Everywhere, Every Day

The onset of the COVID-19 crisis a year ago, with its widespread quarantines and lockdowns, offered telemedicine its moment to shine after years of under-fulfilled promise. As states look toward a post-pandemic world it's time to build on that promise.

Twitter: @JELagasse
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