Article Figures & Data
Tables
Expense Type Definition Example Start-up Expenses specifically incurred in preparation for delivery of the intervention Value of staff time spent planning intervention, acquired assets (eg, HIT), or training new or existing staff Developmental start-up Start-up expenses incurred in establishing the foundation of the intervention and typically unrelated to the scale of implementation Value of staff time spent on intervention planning, negotiating intra- or inter-organizational agreements, creating intervention tools, or re-tooling HIT systems General start-up Start-up expenses incurred to initiate a developed intervention and typically related to the scale of implementation Value of staff time spent on intervention training or purchased assets (eg, computers, software, screening tools) needed to implement the intervention Ongoing Expenses specifically incurred in delivering the intervention Direct and administrative staff time, assets, or supplies used to provide intervention Effort Any expense incurred in support of the ACT intervention, regardless of whether the expense emanated from new or existing resources Value of time spent on intervention by existing staff and staff newly hired to accomplish intervention. Use of existing facilities and supplies and newly acquired assets specific to the intervention Incremental Expenses emanating only from new (additional) resources acquired to develop or implement the intervention. Value of time spent on intervention by staff newly hired to accomplish intervention or newly acquired assets specific to the intervention Direct staff Expenses incurred to compensate patient facing staff involved in the intervention Value of time spent by clinical or front desk staff that interact with patients in preparing for or providing intervention Administrative staff Expenses incurred to compensate staff supporting intervention without direct patient interaction. Value of time spent by practice management, clinical supervisors, HIT or other support staff in preparing for or providing intervention. Non-staff direct Non-staff expenses for items that could be directly and entirely tied to the intervention Computers, software, license fees, supplies, or travel purchased specifically to accomplish intervention Overhead Non-staff expenses that could be attributed in part to the intervention, but are neither distinctly nor entirely associated with it Portions of rent, utilities or other pooled or general practice expenses that can be allocated or assigned to intervention activities Abbreviation: HIT, health information technology.
ID Patient Screening Type Direct Staff FTE New Hires for Intervention Large-Asset Investment (IT/Space Build-Out) 19 Systematic <20 No Yes/yes Description: CMHC developed a new integrated care clinic; this included building a new facility and bringing on a primary care team. Systematic screening is accomplished via a Web tablet at check-in. The practice developed a Health Tracker that extracts selected information from two separate behavioral health and medical EHRs to provide information about patients' behavioral and physical health needs at the point of care. 16 Systematic 20 to 50 No No/no Description: A research team is working with an FQHC with an onsite behavioral health provider and patient navigators to develop a screening tool that assesses patients' behavioral health needs and treatment preferences. Clinic and research staff implemented this tool with the goal of establish consistent screening and referral of patients to their preferred treatment. 18 Clinician discretion >50 Yes No/yes Description: This was a partnership between a FQHC system, a substance abuse treatment center and a CMHC. The CMHC was the site of the intervention. A team that included a physician's assistant, medical assist, care coordinator, and substance abuse counselor moved among three CMHCs to make primary care and substance use services available to patients at each site. 14 Clinician discretion 20 to 50 No No/no Description: This system colocated behavioral health providers in primary care clinics to provide patients with solution-focused interventions and to facilitate referral to other organizational resources (eg, long-term therapy, case management). Behavioral health providers also provided some consultations to medical clinicians upon request. 9 Systematic <20 Yes No/no Description: Privately owned primary care practice partnered with a CMHC to hire, train, and supervise a colocated behavioral health provider. Practice also expanded its health coach services. Practice systematically screened patients at check-in using paper based tool with follow-up screening administered by Medical Assistant during intake, as needed. Patients connected with behavioral health provider or health coach, as needed. 7 Systematic >50 Yes Yes/no Description: Privately owned primary care practice automated behavioral health screening by implementing web-tablets at check-in. The practice worked with information technology partners to develop coding necessary to integrate data into their EHR, and hired and colocated a psychologist to address patients' needs. They continue to expand their behavioral health staff. 12 Clinician discretion <20 No No/no Description: FQHC increased screening and behavioral health services for newly identified pregnant women by adding a psychology fellow who screened patients, offered brief therapy, and followed up with patients as needed. All eligible patients received a followup screen at 6 weeks postpartum. 4 Systematic 20 to 50 Yes No/no Description: A postdoctoral psychology training program partnered with an FQHC serving seniors to implement an enhanced, computerized cognitive and psychological screening. The team implemented and tracked clinical use of the screening, provided a summary report to clinicians, and followup treatment to patients as requested 10 Systematic <20 Yes No/no Description: Solo, privately owned primary care practice partnered with CMHC to embed a behavioral health provider into the practice. The practice systematic screened patients at check-in and intake. Behavioral health provider delivered therapy to patients most with poorly controlled chronic diseases, and most in need of services. 13 Clinician discretion 20 to 50 No No/no Description: Privately owned family practice collaborated with a privately owned behavioral health center to integrate care. A behavioral health provider was colocated in the primary care practice. The behavioral health center expanded services into the family practice by delivering trainings on integration, colocating a behavioral health provider to increase consultations and warm handoffs, and implementing systematic screening. CMHC, community mental health center; EHR, electronic health record; FTE, full-time equivalent; IT, information technology.
Practice ID Start-Up Expense Type Duration, mo Staff Expense Non-Staff Expense Total Direct Admin Direct Overhead 19 Total, $ 10 4137 38,537 129,251 14,023 185,949 Developmental, % 10 79.4 20.6 62.4 26.3 51.4 16 Total, $ 11 1357 4019 1222 276 6874 Developmental, % 11 88.8 49.0 36.8 23.7 53.7 18 Total, $ 13 10,440 36,563 10,625 15,405 73,033 Developmental, % 13 0.0 24.6 0.0 3.4 13.0 14 Total, $ 1 649 143 122 0 914 Developmental, % 1 0.0 0.0 0.0 0.0 0.0 9 Total, $ 5 20,980 2128 9450 12,360 44,918 Developmental, % 5 62.9 45.4 13.2 61.3 51.2 7 Total, $ 24 16,605 13,542 31,100 14,399 75,645 Developmental, % 24 98.9 64.6 2.9 83.5 50.3 12 Total, $ 2 5564 16,096 2645 388 24,694 Developmental, % 2 15.4 31.7 5.7 27.5 25.2 4 Total, $ 1 573 326 1000 528 2427 Developmental, % 1 12.5 0.0 0.0 20.0 7.3 10 Total, $ 5.5 4681 3820 2733 644 11,879 Developmental, % 5.5 30.1 23.9 0.0 27.3 21.0 13 Total, $ 6 7940 3823 1618 1047 14,428 Developmental, % 6 41.5 76.5 83.7 52.9 56.3 Overall Total, $ 7.9 7293 11,900 18,977 5907 44,076 Developmental, % 7.9 54.5 31.6 44.7 42.0 42.4 Highest Five (No. 19, 18, 9, 7, and 12) Total, $ 10.8 11,545 21,373 36,614 11,315 80,848 Developmental, % 10.8 58.5 29.7 45.3 42.2 42.6 Lowest Five (No. 16, 14, 4, 10, and 13) Total, $ 4.9 3040 2426 1339 499 7304 Developmental, % 4.9 39.4 47.9 27.0 36.1 39.7 Practice ID Start-up Expense Type Duration, mo Staff Expense Non-Staff Expense Total Direct Admin Direct Overhead 19 Total, $ 10 0 0 129,251 0 129,251 Developmental, % 0.0 0.0 62.4 0.0 62.4 16 Total, $ 11 0 0 1222 0 1222 Developmental, % 0.0 0.0 36.8 0.0 36.8 18 Total, $ 13 2160 0 10,625 0 12,785 Developmental, % 4.8 0.0 0.0 0.0 0.8 14 Total, $ 1 0 0 122 0 122 Developmental, % 0.0 0.0 0.0 0.0 0.0 9 Total, $ 5 1563 0 9450 0 11,013 Developmental, % 71.4 0.0 13.2 0.0 21.5 7 Total, $ 24 137 9574 31,100 0 40,810 Developmental, % 50.0 50.0 2.9 0.0 14.1 12 Total, $ 2 0 3274 2645 0 5920 Developmental, % 0.0 51.1 5.7 0.0 30.8 4 Total, $ 1 326 0 1000 0 1326 Developmental, % 22.0 0.0 0.0 0.0 5.4 10 Total, $ 5.5 1084 0 2733 0 3817 Developmental, % 0.0 0.0 0.0 0.0 0.0 13 Total, $ 6 0 0 1618 0 1618 Developmental, % 0.0 0.0 83.7 0.0 83.7 Overall Total, $ 7.9 527 1285 18,977 0 20,788 Developmental, % 25.8 50.3 44.7 0.0 44.5 Highest Five (No. 19, 18, 9, 7, and 12) Total, $ 10.8 772 2570 36,614 0 39,956 Developmental, % 33.4 50.3 45.3 0.0 45.4 Lowest Five (No. 16, 14, 4, 10, and 13) Total, $ 4.9 282 0 1,339 0 1621 Developmental, % 5.1 0.0 27.0 0.0 23.2 Practice ID Patient Volume Staff, $ Non-Staff, $ Total Direct Admin Direct Overhead 19 516 9.89 2.61 6.63 4.67 23.80 16 34 7.93 10.28 0.12 1.29 19.63 18 200 31.42 27.31 0.00 5.80 64.54 14 79 47.16 39.52 0.00 36.66 123.34 9 267 14.75 4.68 6.78 20.48 46.69 7 1049 5.01 9.64 0.00 0.71 15.36 12 83 1.13 25.37 0.00 3.36 29.86 4 130 4.38 0.00 0.00 11.37 15.75 10 541 6.60 3.10 0.03 5.15 14.89 13 98 14.08 17.40 0.00 18.56 50.04 Practice Average 299 14.24 13.99 1.36 10.80 40.39 Highest Five (No. 18, 14, 9, 12, and 13) 145 21.71 22.86 1.36 16.97 62.89 Lowest Five (No. 19, 16, 7, 4, and 10) 454 6.76 5.12 1.36 4.64 17.88 Practice ID Patient Volume Staff, $ Non-Staff, $ Total, $ Direct Admin Direct Overhead 19 516 0.00 0.00 6.63 0.00 6.63 16 34 0.00 0.00 0.12 0.00 0.12 18 200 9.65 0.00 0.00 0.95 10.60 14 79 0.00 0.00 0.00 0.00 0.00 9 267 4.70 0.00 6.78 4.94 16.41 7 1049 4.54 0.00 0.00 0.22 4.76 12 83 0.00 0.00 0.00 0.00 0.00 4 130 1.59 0.00 0.00 4.09 5.68 10 541 0.89 0.00 0.03 0.69 1.62 13 98 0.00 0.00 0.00 0.00 0.00 Practice Average 299 2.14 0.00 1.36 1.09 4.58 Highest Five (No. 19, 18, 9, 7, and 4) 432 3.37 0.00 2.69 2.13 8.19 Lowest Five (No. 16, 14, 12, 10, and 13) 167 0.00 0.00 0.03 0.00 0.03
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