Behavioral health is 65.6% of all telehealth visits in the US, up from 18.4% in 2018, according to Trilliant Health’s 2026 behavioral health study. People usually use that number to say that virtual care helps individuals get care. A 2026 cohort study in JAMA Network Open had 17,742 Medicare mental health specialists. It had a different result – clinicians who were almost fully virtual had 0.88 percentage points more rural patients than clinicians who were in person and had 3.55 percentage points fewer new patients. The count of visits changed. The group of people didn’t change much. For a practice that has 2 – 50 practitioners, the fact is that how you plan capacity, not the visit type, controls if virtual care is for new people.
The two numbers side by side
When those two points are together, the common point about access is harder to support:
- 65.6% of telehealth visits in 2024 were behavioral health, up from 18.4% in 2018
- 0.88 percentage points (95% CI, 0.35 – 1.39) is the difference in rural patients for the top group of specialists using telemedicine compared to the bottom group, from data in 2023
One number is about the method of care – the other number is about the individuals that get it. They changed by different amounts.
What the study measured
The JAMA Network Open study had Medicare fee-for-service claims from 2018 – 2023. Researchers put 17,742 mental health specialists into 4 groups based on their telemedicine use in 2021. Then they checked who their patients were through 2023. Specialists in the highest group had more rural patients, more patients in areas with few doctors, more patients from other states and more patients who were 20 or more miles away. Each difference was close to one percentage point.
The study has two limits – It is about Medicare fee-for-service; commercial plans and Medicaid might be different. The groups were based on use in 2021, when care wasn’t normal. The result is still valid.
The result that matters more
The result that’s important for a practice with more patients over time isn’t the rural count – it is that specialists who had the most telemedicine visits had fewer new patients, by 3.55 percentage points (95% CI, -5.73 to -1.38). Telemedicine didn’t mean more open spots – In this study, it was linked to fewer open spots. If virtual care was for people that couldn’t get a visit before, you would see the opposite.
Why virtual care didn’t reach more people
The reason is that clinicians changed how they saw existing patients instead of adding more patients. A clinician who has a full schedule plus adds video doesn’t have more hours – they have the same hours in a different way, with less travel and fewer empty times. Current patients have less trouble getting to visits. The list of individuals waiting isn’t shorter. Less trouble for current patients is a fact – It isn’t the same as giving care to new people and individuals mix them up often.
| What you change | Effect on current patients | Effect on new patients |
|---|---|---|
| Adding video visits | Fewer cancelled visits, simpler next visits | Small on its own |
| Holding spots for new patients | No change | Direct |
| Simpler intake forms online | Small | Direct |
| Having licenses in many states | No change | Direct, when people want care |
| Checking the waitlist often | Visits happen in open spots | Indirect but you can count it |
What to change to have more patients
If the goal is to see individuals that aren’t your patients now, the tools are in how you set up your time and intake, not in the video program:
- Keep spots for new patients – set spots for each clinician each week so they exist. If you don’t keep them, current patients will take them.
- Count the days till the third open spot, not total hours worked. Having all hours full with a wait of 4 weeks means the practice has no room for new people.
- Make intake shorter – when patients finish registration, consent, insurance and medical forms before the first visit, they are more likely to have a visit instead of just asking about one.
- Know where your referrals are from – a video link isn’t the reason people in a new town want care; relationships with other doctors and listings are.
- Use the waitlist – open spots from cancellations are the least expensive way to have new patients, if a system puts individuals in them.
The reimbursement limit
Commercial payers pay different amounts for the same psychotherapy CPT codes. Trilliant Health states that those amounts differ by up to 7 times across the country. The data comes from one payer – it only shows the difference between the highest and lowest payments. It isn’t an average for the whole market. Even when an insurer covers a service, they might pay less for it. A practice that has more virtual appointments for patients whose insurance pays low rates will have less money.
Platform choice
How you set up your schedule controls how many patients you can treat. Because of this the functions of the software are more important than the video resolution. You need to know how the software handles scheduling rules, intake forms and automated waitlists and counts of new patients. This is why practices use platforms instead of only video tools. Many behavioral health practices look at white label telehealth platforms because they want their own name on the system. Those systems have scheduling, intake and messaging, data tools in one place. More than 200 clinics have Healee’s software – it has managed over 5 million appointments for over 1 million patients. This high volume shows software errors in scheduling before new customers start using it.
You should check if a platform matches how you work – you can request a demo and ask about rules for new patient appointments and how to set up intake forms.
Frequently asked questions
Does telehealth help patients get behavioral health care?
To an extent – It helps current patients continue their care and attend appointments. A 2026 study in JAMA Network Open showed that specialists who had the most telemedicine appointments only had 0.88 percentage points more rural patients. Telehealth by itself doesn’t bring in many new groups of patients.
Why is behavioral health the main use for telehealth?
Behavioral health care is talk based – It doesn’t require a physical exam for most visits. Patients have privacy and can pick their times. Because of this the care works well on computers – it was 65.6% of all telehealth visits in 2024.
Did virtual care allow mental health specialists to take on more new patients?
No. In the Medicare group from the study, doctors who had more telemedicine visits had 3.55 percentage points fewer new patients. The data shows doctors changed their current patients to video rather than adding new people.
What lets a virtual practice take more new patients?
Specific times reserved for new patients, online intake that patients fill out themselves quickly, an automatic waitlist, tracking the time patients wait for a visit, groups that send you patients. The use of video is less important than those processes.
Does this mean telehealth is bad for a small practice?
It is useful but for other reasons – patients miss fewer appointments, follow up visits are simpler to hold and clinicians have control over their hours. You can get those results but you must arrange your schedule on purpose if you want more total patients.
Sources:
- Mental Health Specialist Telemedicine Uptake and Patient Location – JAMA Network Open, 2026
- More Demand, Inadequate Supply, Higher Costs: An Examination of America’s Behavioral Health Crisis – Trilliant Health, 2026