Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system

Health Serv Res. 2020 Dec;55(6):913-923. doi: 10.1111/1475-6773.13592.


Objective: To describe the cost of using evidence-based implementation strategies for sustained behavioral health integration (BHI) involving population-based screening, assessment, and identification at 25 primary care sites of Kaiser Permanente Washington (2015-2018).

Data sources/study setting: Project records, surveys, Bureau of Labor Statistics compensation data.

Study design: Labor and nonlabor costs incurred by three implementation strategies: practice coaching, electronic health records clinical decision support, and performance feedback.

Data collection/extraction methods: Personnel time spent on these strategies was estimated for five broad roles: (a) project leaders and administrative support, (b) practice coaches, (c) clinical decision support programmers, (d) performance metric programmers, and (e) primary care local implementation team members.

Principal finding: Implementation involved 286 persons, 18 131 person-hours, costing $1 587 139 or $5 per primary care visit with screening or $38 per primary care visit identifying depression, suicidal thoughts and/or alcohol or substance use disorders, in a single year. The majority of person-hours was devoted to project leadership (35%) and practice coaches (34%), and 36% of costs were for the first three sites.

Conclusions: When spread across patients screened in a single year, BHI implementation costs were well within the range for commonly used diagnostic assessments in primary care (eg, laboratory tests). This suggests that implementation costs alone should not be a substantial barrier to population-based BHI.

Keywords: behavioral health integration; practice coaching; primary care; quality improvement.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Benchmarking
  • Costs and Cost Analysis
  • Decision Support Systems, Clinical / economics
  • Delivery of Health Care, Integrated / organization & administration*
  • Electronic Health Records / economics
  • Employee Performance Appraisal / economics
  • Health Services Research
  • Leadership
  • Mass Screening / economics*
  • Mental Disorders / diagnosis*
  • Personnel Staffing and Scheduling / economics
  • Primary Health Care / economics
  • Primary Health Care / organization & administration*
  • Time Factors