Semester

Spring

Date of Graduation

2019

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Systems and Policy

Committee Chair

Usha Sambamoorthi

Committee Co-Chair

Nilanjana Dwibedi

Committee Member

Nilanjana Dwibedi

Committee Member

Traci J. LeMasters

Committee Member

Kim K. Innes

Committee Member

Sandipan Bhattacharjee

Abstract

Mental health conditions (MHCs) are the most expensive conditions in the United States (US). The high MHC prevalence coupled with continued undertreatment of MHC has contributed significantly to this high economic burden. Despite policy changes to increase mental health parity and integrate mental and physical healthcare, the shortage of mental health providers remains a significant barrier to mental health (MH) treatment. Telemental health (TMH) has emerged as an alternative care delivery approach to meet the growing demand of MH care and shortages of MH providers. Understanding the adoption of TMH among mental health facilities is critical for informing the broad implementation of TMH in the delivery system of mental healthcare. As the use of TMH is determined by not only "supply" but also "demand," it is also important to understand TMH use among adults with MHC. Given that commercial insurance plays an important role in paying for mental health services and telehealth services, it is imperative to examine TMH use and the impact of TMH use on healthcare costs among commercially insured adults with MHC in real-world care settings. Therefore, this dissertation pursued three related aims: 1) to estimate TMH adoption and examine factors associated with TMH adoption among mental health facilities; 2) to characterize TMH use and identify factors associated with TMH use among commercially insured adults with MHC; and 3) to evaluate how TMH use influences healthcare costs. To comprehensively present TMH state of the art within the current mental health delivery system, the study used diverse data sources. These data sources were: the National Mental Health Services Survey (N-MHSS) for years 2011-2016; a geographically diverse claims database for commercially insured adults for years 2010-2017; the latest Area Health Resources File (2016-2017); and national reports of telehealth policies. We found that about one in four mental health facilities in the US adopted TMH in 2016. TMH adoption might be hindered by low facility-level information technology capacity and by state licensure requirements for cross-state telehealth practice. TMH use among adults with MHC was low (16 in 10,000) in this study of a commercially insured population. Current TMH use among adults with MHC was driven mainly by a greater need to access mental health specialists. TMH use was associated with increased MH service use and higher MH-related costs. However, TMH use did not have a significant impact on total third-party healthcare costs. In summary, these findings highlight the need for collaborative efforts by policymakers, payers, and providers to increase the availability of TMH in mental health care delivery, and thereby increase access to mental healthcare services for adults with MHC. Further research is needed to confirm and extend our study findings; specifically, studies are needed to examine how TMH use affects the cost of mental and physical health care separately, and to explore whether TMH use can lead to cost-savings over a longer period among adults with different MHCs.

Embargo Reason

Publication Pending

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