Start-up and incremental practice expenses for behavior change interventions in primary care

Area of Science:

• Health Services Research
• Primary Care Medicine
• Behavioral Science

Background:

• Routine delivery of behavior-change services in primary care necessitates adequate provider compensation.
• Estimating practice expenditures for these services is essential for establishing appropriate payment models.

Purpose of the Study:

• To estimate the costs incurred by primary care practices when providing behavior-change interventions.

Main Methods:

• Collected in-practice expenditure data for ten interventions across 29 practices in U.S. practice-based research networks (2006-2007).
• Utilized a standardized instrument and analyzed data using templates to estimate start-up and implementation phase expenses.

Main Results:

• Average monthly start-up expenses were $1860 per practice, primarily for staff training.
• Average monthly incremental costs were $58 per patient participant ($15 direct care, $43 overhead).
• Patient recruitment and screening constituted the largest portion of intervention expenditures.

Conclusions:

• Primary care practices face substantial costs ($1860 initiation, $58/patient/month implementation) for systematic behavior change support.
• Readily available behavior change services in primary care are unlikely until payment systems account for these practice expenses.