Expense of Behavioral Health and Primary Care Integration
Overall, the incremental start-up and ongoing expenses reported across the variety of ACT program behavioral health and primary care integration interventions suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. From a practice perspective, and particularly when measuring effort or "full" practice expenditures, start-up and ongoing expenses are not trivial and may well pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider means to provide external support to practices that account for both incremental and effort expense levels. Development of knowledge-transfer mechanisms such as standardized intervention models and tools or learning collaboratives could help to reduce start-up effort expenditures. Reimbursement and purchasing mechanisms that reflect the full value of these interventions from a Triple Aim perspective, and not simply incremental expenses, are likely necessary to assure the widespread diffusion of these practice innovations.
Conclusion
Overall, the incremental start-up and ongoing expenses reported across the variety of ACT program behavioral health and primary care integration interventions suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. From a practice perspective, and particularly when measuring effort or "full" practice expenditures, start-up and ongoing expenses are not trivial and may well pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider means to provide external support to practices that account for both incremental and effort expense levels. Development of knowledge-transfer mechanisms such as standardized intervention models and tools or learning collaboratives could help to reduce start-up effort expenditures. Reimbursement and purchasing mechanisms that reflect the full value of these interventions from a Triple Aim perspective, and not simply incremental expenses, are likely necessary to assure the widespread diffusion of these practice innovations.
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