Volume 55 | Number 6 | December 2020

Abstract List

Kai Yeung PharmD, PhD, Julie Richards MPH, Eric Goemer BA, Paula Lozano, Gwen Lapham PhD, MPH, MSW, Emily Williams PhD, MPH, Joseph Glass, Amy Lee MPH, Carol Achtmeyer MS, AR, NP, Ryan Caldeiro MD, Rebecca Parrish LICSW, Katharine Bradley MD, MPH


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.


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.