Use of Administrative Data to Identify Potential Service Gaps for Individuals With Serious Mental Illness

Objective: The New York City Mental Health Care Monitoring Initiative uses Medicaid claims data to identify individuals with serious mental illness who are experiencing or at risk for gaps in services. In this study the authors assessed whether proposed service use algorithms accurately identified such individuals. Methods: A random sample of 500 individuals with serious mental illness was identified. Individuals belonged to specific high-need cohorts and met predefined claims-based criteria for potential service gaps. Clinical staff initiated reviews with prior service providers for 230 individuals. Results: Over a two-week period staff completed reviews for 188 cases (88%). In 66 cases (35%) the individual was fully engaged in care; 84 (45%) had a recent episode of disengagement that was appropriately addressed, and 38 (20%) were not receiving adequate services. Conclusions: The proposed service use algorithms successfully identified high-need individuals with serious mental illness at risk for gaps in services. (Psychiatric Services 62:1094-1097, 2011)