title: Start-Up and Ongoing Practice Expenses of Behavioral Health and Primary Care Integration Interventions in the Advancing Care Together (ACT) Program.
abstract: OBJECTIVE
  Provide credible estimates of the start-up and ongoing effort and incremental practice expenses for the Advancing Care Together (ACT) behavioral health and primary care integration interventions.
  
  
  METHODS
  Expenditure data were collected from 10 practice intervention sites using an instrument with a standardized general format that could accommodate the unique elements of each intervention.
  
  
  RESULTS
  Average start-up effort expenses were $44,076 and monthly ongoing effort expenses per patient were $40.39. Incremental expenses averaged $20,788 for start-up and $4.58 per patient for monthly ongoing activities. Variations in expenditures across practices reflect the differences in intervention specifics and organizational settings. Differences in effort to incremental expenditures reflect the extensive use of existing resources in implementing the interventions.
  
  
  CONCLUSIONS
  ACT program incremental expenses suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. Practice effort expenses are not trivial and may pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider external support to practices that accounts for both incremental and effort expense levels. Existing knowledge transfer mechanisms should be employed to minimize developmental start-up expenses and payment reform focused toward value-based, Triple Aim-oriented reimbursement and purchasing mechanisms are likely needed.
authors.affiliation: From Portland State University, Portland OR, (NTW); Oregon Health & Science University, Portland, OR, (DJC, RG); Kaiser Permanente Colorado, Denver, CO (AB); Milliman, Denver, CO (SM); Jefferson Center for Mental Health, Lakewood, CO (DB); University Colorado, Denver, Denver, CO (LAG). nwallace@pdx.edu.
authors.forename: Neal T
authors.initials: NT
authors.lastname: Wallace
authors.affiliation: From Portland State University, Portland OR, (NTW); Oregon Health & Science University, Portland, OR, (DJC, RG); Kaiser Permanente Colorado, Denver, CO (AB); Milliman, Denver, CO (SM); Jefferson Center for Mental Health, Lakewood, CO (DB); University Colorado, Denver, Denver, CO (LAG).
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: From Portland State University, Portland OR, (NTW); Oregon Health & Science University, Portland, OR, (DJC, RG); Kaiser Permanente Colorado, Denver, CO (AB); Milliman, Denver, CO (SM); Jefferson Center for Mental Health, Lakewood, CO (DB); University Colorado, Denver, Denver, CO (LAG).
authors.forename: Rose
authors.initials: R
authors.lastname: Gunn
authors.affiliation: From Portland State University, Portland OR, (NTW); Oregon Health & Science University, Portland, OR, (DJC, RG); Kaiser Permanente Colorado, Denver, CO (AB); Milliman, Denver, CO (SM); Jefferson Center for Mental Health, Lakewood, CO (DB); University Colorado, Denver, Denver, CO (LAG).
authors.forename: Arne
authors.initials: A
authors.lastname: Beck
authors.affiliation: From Portland State University, Portland OR, (NTW); Oregon Health & Science University, Portland, OR, (DJC, RG); Kaiser Permanente Colorado, Denver, CO (AB); Milliman, Denver, CO (SM); Jefferson Center for Mental Health, Lakewood, CO (DB); University Colorado, Denver, Denver, CO (LAG).
authors.forename: Steve
authors.initials: S
authors.lastname: Melek
authors.affiliation: From Portland State University, Portland OR, (NTW); Oregon Health & Science University, Portland, OR, (DJC, RG); Kaiser Permanente Colorado, Denver, CO (AB); Milliman, Denver, CO (SM); Jefferson Center for Mental Health, Lakewood, CO (DB); University Colorado, Denver, Denver, CO (LAG).
authors.forename: Donald
authors.initials: D
authors.lastname: Bechtold
authors.affiliation: From Portland State University, Portland OR, (NTW); Oregon Health & Science University, Portland, OR, (DJC, RG); Kaiser Permanente Colorado, Denver, CO (AB); Milliman, Denver, CO (SM); Jefferson Center for Mental Health, Lakewood, CO (DB); University Colorado, Denver, Denver, CO (LAG).
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
mesh_terms: D003120:Colorado; D003156:Community Mental Health Services / Q000191:economics* / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D005102:Health Expenditures; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D011216:Practice Management, Medical / Q000191:economics* / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration
keywords: Delivery of Health Care; Integrated