title: The cost of sustaining a patient-centered medical home: experience from 2 states.
abstract: OBJECTIVE
  As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these "advanced primary care" functions. A key required input is personnel effort. This study's objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards.
  
  
  METHODS
  We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions.
  
  
  RESULTS
  Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado.
  
  
  CONCLUSIONS
  Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions.
authors.affiliation: University of Utah, School of Medicine, Department of Family and Preventive Medicine, Salt Lake City, Utah Michael.Magill@hsc.utah.edu.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Magill
authors.affiliation: Integrated Physician Network, Louisville, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Ehrenberger
authors.affiliation: University of Utah, School of Medicine, Department of Family and Preventive Medicine, Salt Lake City, Utah University of Utah, David Eccles School of Business, Department of Marketing, Salt Lake City, Utah.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Scammon
authors.affiliation: University of Utah Medical Group, Salt Lake City, Utah.
authors.forename: Julie
authors.initials: J
authors.lastname: Day
authors.affiliation: University of Utah, School of Medicine, Department of Family and Preventive Medicine, Salt Lake City, Utah.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Allen
authors.affiliation: University of Utah, David Eccles School of Business, Department of Marketing, Salt Lake City, Utah.
authors.forename: Andreu J
authors.initials: AJ
authors.lastname: Reall
authors.affiliation: Crosslin and Associates, Nashville, Tennessee.
authors.forename: Rhonda W
authors.initials: RW
authors.lastname: Sides
authors.affiliation: University of Utah, School of Medicine, Department of Family and Preventive Medicine, Salt Lake City, Utah.
authors.forename: Jaewhan
authors.initials: J
authors.lastname: Kim
mesh_terms: D003120:Colorado; D003365:Costs and Cost Analysis; D006801:Humans; D018802:Patient-Centered Care / Q000191:economics* / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014589:Utah
keywords: costs and cost analysis; health services research; medical home; patient-centered care; primary health care