New Research Shows Improved Psychiatric Care Accessibility, Cost-Saving Benefits for Patients and Payers

Jacqueline Pesa, PhD, director, population health research, Janssen Scientific Affairs, discusses recent research presented at the American Psychiatric Association annual meeting, and explains why providers should educate patients about available treatment options, including telehealth and the use of long-acting injectables earlier in their treatment journey to help increase positive clinical outcomes and cost-effectiveness.  

What existing data led you and your co-investigators to conduct this research?

As my research background over the course of my career has been focused on population health and health economics and outcomes, my team and I were interested in understanding the impact COVID-19 was (and still is) having on behavioral health care services, specifically among patients with schizophrenia. Through our literature search, we discovered a recently published scoping document inclusive of six studies that reported high levels of acceptance and high satisfaction with videoconferencing methods among persons with schizophrenia.¹

When the COVID-19 pandemic hit, rates of outpatient health care visits declined substantially and telehealth quickly became a needed option for health care. Early on, the Centers for Medicare & Medicaid Services announced telehealth waivers to reimburse providers for services delivered via telehealth² and preliminary evidence suggests that behavioral health care providers are among the highest users of telehealth-delivered care³. We saw this data and trend shift as an opportunity to delve deeper into understanding mental health telehealth resources. Through our research, we sought to estimate changes in health care resource use among patients with schizophrenia in the early months of the COVID-19 pandemic and presented our findings in a poster session at the American Psychiatric Association (APA) Annual Meeting 2021.⁴

Building upon this, we slightly shifted our focus in another presentation at APA⁵where we presented our findings from a study comparing the clinical and economic outcomes of long-acting injectables (LAIs) in young adults with schizophrenia. We arrived at this research question because we recognized that despite documented clinical and cost-savings benefits of LAIs for adults living with schizophrenia, there was limited real-world research focus on outcomes of younger, commercially insured adult patients (aged 18-35 years) with schizophrenia who are treated with LAIs. Understanding that schizophrenia typically manifests in young adulthood, we saw this as an opportunity to advance the limited research in order to help educate population health decision makers (PHDMs) and treatment providers on the clinical and economic outcomes of LAI treatment for young adults living with schizophrenia. We wanted to address this gap to better understand the potential benefits—both clinically and economically—of LAIs in this patient population and determine if our results correlate with existing guidance and clinical guidelines regarding LAI use in adult patients.  

Please briefly describe each study and the findings. Were any of the outcomes particularly surprising?

In order to estimate changes in health care resource use among patients with schizophrenia in the early months of the COVID-19 pandemic, we conducted a cross-sectional study of medical and pharmacy claims, pulled from Decision Resources Group Real-World Data, among adult patients (≥18 years of age) with schizophrenia between January 1, 2019 and June 30, 2020. To be included in the study, the participants had to meet eligibility criteria of being diagnosed with schizophrenia, identified by ≥2 outpatient claims or 1 inpatient claim associated with a schizophrenia diagnosis code (ICD-10-CM: F20.x, F25.x). Once we had our sample, we then analyzed the data by stratifying the place of service (in person versus telehealth) for monthly rates of all-cause health resource utilization, including: total health care outpatient visits; all-cause psychiatric care; primary care visits; psychotherapy; and community mental health center visits. We presented our results at APA.⁴ Results showed substantial and sustained increases in telehealth delivery, and a decrease in partial day hospitalizations and visits to community mental health centers during the COVID-19 pandemic among adult patients with schizophrenia. From September 2019 to February 2020, only 6.4% of psychiatric care encounters were delivered via telehealth but by June 2020, 69.1% of psychiatry encounters were delivered via telehealth. This steep increase in telehealth service was surprising, as we expected the switch to telehealth to be a slower transition.

We also shared our findings on the clinical and economic comparative outcomes before and after treatment with an LAI in commercially insured young adults with schizophrenia at APA in our second poster presentation.⁵ To achieve our study objective, we designed a retrospective, observational cohort study of young adult (ages 18-35) patients diagnosed with schizophrenia and examined administrative medical and pharmacy claims data that contained enrollment status from inpatient, outpatient, prescription drug, and carve-out services. We also included inpatient admissions, outpatient services, prescription drugs, and costs of all medical services and prescription drugs in our data capture. Once we compiled our data, we analyzed the relapse rate for each individual patient to provide us with better insight into health care resource utilization outcomes. We measured these outcomes by number of inpatient admissions, length of stay, number of ED visits, and a variety of other quantitative measures that are further detailed in the poster. Our findings showed that the use of LAIs in commercially insured young adults with schizophrenia was associated with decreased relapse event rate in the period after LAI initiation as compared with the period before LAI initiation, which in turn was associated with a decrease in health care resource utilization and costs. Although the cost saving benefits of LAIs have been well documented in adults, it is important to note that the results of this study also provided evidence demonstrating that LAI treatment for young adults with schizophrenia is associated with significant cost savings to commercial payers. 

What are the possible real-world applications of these findings in clinical practice?

When we reviewed the results of our study on the Changes in Behavioral Healthcare Service Use Among Patients with Schizophrenia Associated with COVID-19 Pandemic, the most important finding was that telehealth appears to be a viable option for adults with schizophrenia, whether it’s for primary care services or psychiatric care, and telehealth for behavioral health will continue to be used post-pandemic. Although further research is needed to understand the barriers adult patients with schizophrenia may face regarding the use of telehealth services, there is evidence demonstrating the acceptability of telehealth for patients with schizophrenia, creating an opportunity for increased and alternative routes to mental health care.

The COVID-19 pandemic has amplified the need for new techniques and strategies to help patients with schizophrenia access different treatment options and delay relapse. Findings from these two posters presented at APA provide evidence to encourage PHDMs and providers to educate patients about available treatment options including telehealth and the use of LAIs earlier in their treatment journey to help increase positive clinical outcomes and cost-effectiveness. 

Do you and your co-investigators intend to expand upon this research?

We do. Some preliminary data from this same data set showed vastly increased rates of COVID-19 infections among persons with schizophrenia and we are exploring the relationship between these higher rates and social determinants of health such as race/ethnicity.

Is there anything else pertaining to your research and findings that you would like to add?

In addition to the data described above which is being submitted to an upcoming mental health congress, we are planning to submit manuscripts to peer-reviewed journals for all of the work described. 

About Dr Pesa

Jacqui Pesa, PhD, is the group director of population health research at Janssen Scientific Affairs, LLC. She has been working in the health economics and outcomes research world for 2 years and holds a PhD in Health Behavior and MPH in Epidemiology. 

References 

1. Santesteban-Echarri O, Piskulic D, Nyman RK, Addington J. Telehealth interventions for schizophrenia-spectrum disorders and clinical high-risk for psychosis individuals: A scoping review. J Telemed Telecare. 2020;26(1-2):14-20. doi:10.1177/1357633X18794100
2. Centers for Medicare & Medicaid Services. Medicare Telemedicine Health Care Provider Fact Sheet. March 17, 2020. Accessed March 12, 2021. https://www.cms.gov/newsroom/factsheets/medicare-telemedicine-health-care-provider-fact-sheet
3. Mehrotra A, Chernew ME, Linetsky D, et al. The impact of COVID-19 on outpatient visits in 2020: visits remained stable, despite a late surge in cases. February 22, 2021. Accessed March 12, 2021. https://www.commonwealthfund.org/publications/2021/feb/impactcovid-19-outpatient-visits-2020-visits-stable-despite-late-surge.
4. Liberman JN, Pesa J, Petrillo M, Ruetsch C. Changes in behavioral healthcare service use among patients with schizophrenia associated with COVID-19 pandemic. Health Analytics, Janssen Scientific Affairs. Accessed March 12, 2021. http://apothecom.com/review/qrcodes/150109057/APA_PHR-OUT-947_Poster.jpg
5. Fu AZ, Pesa JA, Lakey S, Benson C. Healthcare resource utilization and costs pre-/post-long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia. Janssen Scientific Affairs. http://www.apothecom.com/review/qrcodes/150109058/APA_PALM-OUT-585_206_Poster.jpg