---
type: source
title: "Mental health telemedicine expansion produces only marginal rural access gains — high-telemedicine providers see fewer new patients"
author: "Jorem J, Wilcock AD, Busch AB, Huskamp HA, Mehrotra A (JAMA Network Open)"
url: https://pubmed.ncbi.nlm.nih.gov/41784959/
date: 2026-03-02
domain: health
secondary_domains: []
format: journal-article
status: null-result
priority: high
tags: [mental-health, telehealth, access-equity, rural-health, treatment-gap, mental-health-workforce]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

**Full citation:** Jorem J, Wilcock AD, Busch AB, Huskamp HA, Mehrotra A. "Mental Health Specialist Telemedicine Uptake and Patient Location." JAMA Network Open. 2026 Mar 2;9(3):e260823. PMID: 41784959.

**Study design:** Retrospective analysis of Medicare claims data, 2018-2023. 17,742 mental health specialists. Stratified providers by 2021 telemedicine usage levels (high vs. low). Compared patient geography in 2023 across usage strata.

**Key findings:**

1. Mental health specialists with highest telemedicine use had only **0.88 percentage points** more visits with rural patients compared to low-use providers — a statistically small difference that fails to close the rural access gap.

2. Highest-telemedicine providers saw **3.55 percentage points fewer new patients** compared to low-use providers by 2023. This is the most counterintuitive finding: telemedicine adoption is associated with REDUCED new patient acquisition, suggesting specialists are using telehealth for existing patient relationships rather than to expand access.

3. Small increases for patients in shortage areas (HPSA-designated), different states, and those 20+ miles away — statistically present but clinically marginal.

4. Authors' conclusion: "greater telemedicine uptake was associated with only small increases in the share of visits to patients in rural, low-access-to-care, or distant communities," and "additional policy interventions may be required to achieve telemedicine's potential in addressing access disparities."

**Context:** Data from November 2024-December 2025. Medicare claims sample, so limited to Medicare population (elderly and disabled). Mental health specialists only (psychiatrists, psychologists), not primary care with behavioral health integration.

## Agent Notes

**Why this matters:** This directly tests the hypothesis that telemedicine is closing the mental health access gap for underserved populations. It uses a large, longitudinal national dataset (not a single-center study) and reaches a clear null result: telemedicine expansion among mental health specialists is NOT substantially expanding access to rural or underserved populations. The "fewer new patients" finding is the most important — it reveals the mechanism: telemedicine is being used to maintain existing relationships (greater convenience, less dropout), not to acquire new underserved patients.

**What surprised me:** The 3.55 percentage points FEWER new patients among high-telemedicine providers is genuinely counterintuitive. The intuitive hypothesis is: telemedicine removes geographic barriers → providers see more new patients from distant/rural locations. The finding is the opposite: high telemedicine providers are seeing fewer new patients overall. This suggests telemedicine is primarily a retention tool for existing patients, not an access expansion tool. The "why" isn't fully explained but plausible mechanisms: (1) high telemedicine providers may be filling their capacity with existing patients via convenient virtual follow-ups; (2) new patient acquisition requires in-person trust-building that telemedicine doesn't easily enable.

**What I expected but didn't find:** A clear positive finding showing telemedicine expanding rural mental health access. I expected the geographic reach data to show meaningfully higher shares of rural patients for high-telemedicine providers — even 5-10 percentage points. The 0.88 percentage point difference is a near-null result at scale.

**KB connections:**
- [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]] — this provides strong quantitative evidence for the "serves already-served" mechanism
- [[healthcare AI creates a Jevons paradox because adding capacity to sick care induces more demand for sick care]] — potential parallel: telehealth capacity added to existing relationships rather than expanding to underserved (a retention Jevons paradox)

**Extraction hints:**
- This is the strongest available evidence for the claim that telehealth mental health primarily serves existing patients rather than expanding access to underserved populations
- The "fewer new patients" finding could be extracted as a standalone claim: "Mental health telehealth expansion is associated with reduced new patient acquisition, revealing a retention mechanism that prevents geographic access expansion"
- Confidence: likely (large national dataset, longitudinal, peer-reviewed in JAMA Network Open; limited to Medicare population)

## Curator Notes

PRIMARY CONNECTION: [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]]

WHY ARCHIVED: First large-scale national longitudinal study (n=17,742 providers, 2018-2023 Medicare data) directly testing whether telemedicine expansion improves rural mental health access — null result with counterintuitive "fewer new patients" finding.

EXTRACTION HINT: Focus on the "fewer new patients" mechanism — this explains WHY telemedicine serves existing rather than new patients, which is the core of the "already-served" claim.
