Team-based primary care and virtual and in-person mental health care services: Evidence from changes in virtual care reimbursement policy in Ontario, Canada

The team-based approach involves collaborating primary care physicians with allied healthcare professionals to provide comprehensive patient-centred primary care and mental health care. In Ontario, the most common team-based primary care approach, Family Health Teams (FHTs) has been shown to improve access to in-person primary healthcare services. With the COVID-19 pandemic, physician services delivery shifted from in-person to virtual, and new billing codes for virtual mental health services were introduced in Ontario. Using health administrative data on physicians practicing under FHTs and non-FHTs in Ontario between 2015 and 2022, we exploit the variation in payment policy to compare the number and value of in-person and virtual mental health services provided by FHTs and non-FHTs and their patients' outcomes (hospitalizations and emergency department (ED) visits for mental health reasons). We find that the virtual fee code policy was associated with an increased number of virtual mental health services in FHTs (240.68 services per physician per 1,000 patient-years) and non-FHTs (228.62 services) but with a significantly larger effect in FHTs and with fewer in-person services in both FHTs and non-FHTs. Similar results were found with the dollar values. The policy was associated with fewer ED visits in FHTs and non-FHTs. However, FHTs were associated with increased hospitalizations and ED visits before and after the policy. We find evidence of improved access to virtual care in team-based practices. Although this difference cannot entirely be attributed to the policy’s introduction, it may indicate that team-based practices have adapted more rapidly to virtual care service delivery. • The virtual care reimbursement policy increases virtual mental health services. • The virtual care reimbursement policy reduces in-person mental health services. • The policy effect on virtual care is larger in team-based than non-team-based care. • The policy reduces emergency department visits in team- and non-team-based care. • Team-based care increases hospitalizations and ED visits before and after the policy.