Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis

Abstract

Background COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ≥7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results Overall, the youths and young adults in the remote IOP attended a median of 91% of their scheduled group sessions (mean 85.9%, SD 16.48%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, χ21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7%) no longer reporting it at discharge (142/200, 71%), and in NSSI (N=430, χ21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9%) reporting lower self-harm at discharge (119/205, 58%). No significant differences emerged by insurance type in attendance (median public 89%, median private 92%; P=.10), length of stay (t416=−0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=−0.87 and P=.38; active suicidal ideation: N=200, χ21=0.6 and P=.49; NSSI frequency: t426=−0.98 and P=.33). Conclusions Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes.

The effectiveness of collaborative care delivered via telehealth in a pediatric primary care population

“…Patients in the PHQ-9 group enrolled in Medicaid were nearly 42% less likely to achieve a 50% reduction in PHQ-9 scores at 120 days compared to patients with commercial insurance. A study comparing mental health treatment outcomes among adolescent and young adult patients with public and private insurance found similar reductions in depression, suicidal ideation, and non-suicidal self-injury across groups (27). Patients enrolled in Medicaid are often face additional barriers to treatment engagement, however little research exists to describing the effect of collaborative care on behavioral health outcomes among this group.…”

The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis

“…That is, patients typically present with significant clinical depression and anxiety, histories of trauma, and other co-occurring behavioral challenges (eg, justice system involvement, self-harm, and suicidality). In a previous quality improvement analysis of this population, at treatment intake, nearly half (47.1%) of the participants met criteria for nonsuicidal self-injury, nearly three quarters (70.8%) were at risk for suicide, and more than two-thirds (68.1%) reported moderate to severe depression [40]. The average length of stay in treatment is 10-12 weeks and determined on a case-by-case basis.…”

“…A variety of 1-hour support, psychoeducation, and mutual aid groups are running throughout each week for parents and caregivers to attend. Topics covered in the groups include supporting mindful communication, sibling support group, and "IOP Roadmap," which updates parents on the skills their children are learning each week with tips on how to support them (additional information about Charlie Health IOP programing available in other publications [40]).…”

Impact of State Telehealth Parity Laws for Private Payers on Hypertension Management before and during the COVID-19 Pandemic

“…10 The distinction between these types of parity is crucial, as it can significantly impact access to telehealth services and reimbursement rates for healthcare providers. Moreover, prior research on telehealth has been limited to other settings or services, such as mental health care and psychotherapy, 11,12 and has not specifically assessed hypertension treatment, particularly for private payers.…”