A New Method for Estimating Incidence of First Psychotic Diagnosis in a Medicaid Population

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Amplify OnTrackNY publication summaries summarize peer-reviewed publications focused on quality improvement or research conducted to help us learn & improve the program.

Study snapshot

Identifying first episode psychosis is important to ensure individuals receive needed support and treatment as quickly as possible. This study created a new way to identify individuals experiencing first episode psychosis among persons with Medicaid insurance in the state of New York from2013 to 2017.¹  

This study asks:

According to records from the New York State Medicaid program between 2013 to 2017, how many first diagnoses of psychosis occurred in individuals between the ages of 15 to 35 years old?

What data were used in this study?

The study analyzed 31,606 records with a first diagnosis of psychosis recorded during the 5-year study period.

Study findings

Using information from the New York State Medicaid billing system, the authors:

• Evaluated the characteristics of individuals who received a diagnosis of first episode psychosis
• Calculated the number of individuals with newly diagnosed first- episode psychosis
• Confirmed that the estimates of new diagnoses were accurate by reviewing records.
   

Finding 1. The study found a higher rate of first episode psychosis for the Medicaid fee-for-service program, males, people of color, younger individuals, and individuals in outpatient mental health settings.

Finding 2. Higher rates of first-episode psychosis diagnoses were found among those who received Medicaid (272 per 100,000) compared to previous studies that evaluated rate of diagnoses among individuals with private insurance (86 per 100,000 for those ages 15-29, and 46 per 100,000 for those ages 30-59).

Final thoughts

Study findings suggest that administrative data algorithms may be useful to providers, Medicaid managed care organizations, and state Medicaid authorities to support early intervention. This method is especially important to support identification of first episode psychosis in vulnerable groups, such as individuals who are younger, have intellectual disabilities, and have complex health needs.

References

1. Radigan M, Gu G, Frimpong EY, Wang R, Huz S, Li M, Nossel I, & Dixon L. A New Method for Estimating Incidence of First Psychotic Diagnosis in a Medicaid Population. Psychiatric services. 2019 August 1; 70(8): 665– 673. https://doi.org/10.1176/appi.ps.201900033. 

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