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Updated: Jan 27, 2026

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
Estimated Staff Time Effort, Costs, and Medicaid Revenues for Coordinated Specialty Care Clinics Serving Clients With
Thomas E Smith1, Margaret Kurk1, Rishi Sawhney1
1New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column.
Abstract:
As coordinated specialty care for first-episode psychosis is implemented nationally, questions arise regarding financial sustainability. To address this, New York State undertook a time study in which 13 coordinated specialty care sites reported all activities provided to 75 randomly selected Medicaid clients with first-episode psychosis over a 2-week period. The average estimated cost was $1,375 per client per month, yet under optimal billing conditions, estimated revenues were only $662 per client per month, or 48% of the costs. These results underscore the need for continued subsidies and novel payment schemes for coordinated specialty care.
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