Jadon Nielsen
Pronouns: he/him/his
Research Mentor(s): Antonios Koumpias
Research Mentor School/College/Department: Social Sciences, College of Arts and Sciences, University of Michigan-Dearborn / Other
Program: UROP
Session: Session 4 (1:40pm – 2:30pm)
Authors: Jadon Nielsen
Abstract
This study examines the effects of telehealth policy variation introduced during the COVID-19 public health emergency on healthcare utilization and cost of care of mental health visits of COVID-19 patients from 2019 through 2022 in 16 U.S. states across all Census regions. We exploit exogenous variation in access to care across state lines generated by waivers, permanent or temporary, of in-state telehealth licensure requirements, patient-physician pre-existing relationship requirements, private payer or payment parity laws to isolate their causal effect on mental health use and cost. To minimize confounding variation from local conditions, we focus on policy discontinuities within 8 metropolitan statistical areas that straddle a state border. The empirical analysis combines information from patient-level electronic health records from commercial insurance and Medicare Advantage patients with comparative case study designs. Specifically, de-identified claims with service-line detail provided by Change Healthcare that cover nearly half of all commercial claims in the U.S. are used. To disentangle the utilization and cost impacts that may be causally attributed to state-specific policy changes, we use a standard difference-in-differences model and conduct event study falsification tests. Given the importance of pre-existing patient-physician relationships, we further control for baseline differences in the average rate of pre-existing relationship patient visits at the local, 3-digit zip-code level in 2019 in a triple difference study design. Our estimates may be interpreted as the upper bound of the effect of licensure policy changes on out-of-state telehealth utilization. This research provides policymakers with valuable insights into the effectiveness of telehealth waivers in increasing access to care and the consequences of waiver rescindments in resurfacing shortages of care.
