A remote care navigation solution associated with improved utilization and outcomes of mental healthcare: A nationwide cohort study in the USA.

Abstract

To examine how clinical care navigation-assistance in accessing healthcare and social services-relates to mental healthcare utilization and clinical outcomes, and whether effects are consistent for people of color. This retrospective cohort study included participants using a digital mental health benefit (Spring Health), sponsored by 2,045 US employers from 2018-2023. Participants had access to therapists and Care Navigators, clinicians who help select treatment options and schedule appointments. Primary measures were care utilization (conversion to care, multiple-session attendance) and clinical effectiveness (treatment duration, PHQ-9 depression scale, GAD-7 anxiety scale). 36,964 participants had at least 1 mental health assessment and complete demographic information. 13,122 participants who used care navigation were matched to 23,842 participants who did not with 1:2 propensity score matching using demographic and clinical characteristics. Care navigation was associated with increased therapy utilization (OR, 7.10; 95% CI, 3.36-15.00, P < 0.001), multiple-session attendance (OR, 1.57; 95% CI, 1.46-1.69, P < 0.001), number of treatment sessions (IRR, 1.36; 95% CI, 1.33-1.39, P < 0.001), additional clinical improvement (depression: 0.93 points, 95% CI, 0.11-1.75; anxiety: 0.87 points, 95% CI, 0.12-1.62) compared to therapy alone for participants with severe baseline symptoms. White participants and participants of color had similar outcomes. Participants using care navigation had improved mental healthcare utilization, retention, and reduced depression and anxiety, which was consistent for people of color. Clinical implementation of care navigation may be associated with greater engagement in care, a key requisite for improving treatment outcomes.