Tool to Assess Ongoing Costs of PCMH Project Summary/Abstract The Patient-Centered Medical Home (PCMH) model is expected to help achieve the triple aims of access, quality, and cost effectiveness. Transformation of a practice to a PCMH model requires many changes, including addition of new staff to perform new services, new work flows and systems to implement new avenues for patient access, and new systems to manage the health of a population of patients. Many of these activities and the infrastructure to support them are not covered by current reimbursement models. As practices are transforming to a PCMH model, it is essential that sufficient up-front investments be made available so that practices can create the infrastructure necessary to support high-quality, safe, continuous, coordinated, comprehensive care. It is critical to develop knowledge about the costs of on-going maintenance of the new services required in a PCMH model. With this project, we have an important opportunity to contribute to effective primary care payment reform and to the sustainability of primary care transformation by rigorously defining costs for maintaining PCMH practices. This project will apply a PCMH Cost Dimensions Tool developed to assess the costs to practices associated with activities to achieve PCMH recognition status in 21 practices that differ with regard to their: 1) NCQA PCMH Recognition status (Level III or not), 2) ownership (network of centrally owned practices or independent practices), 3) payers (fee-for-service commercial plans, Medicare, Medicaid, Federally Qualified Health Centers), and 4) patient populations (socio-economic status, health status). Applying the PCMH Cost Dimension Tool in these diverse settings will allow us to examine the ways in which practices and their associated cost structures differ across settings. The findings from this study will be useful to a variety of stakeholders. They will be useful to payers in establishing financial incentives for practices to implement and operate PCMH practices. They will be useful to policy makers in establishing programs that encourage and support the development of PCMH practices. They will be useful to practices in predicting the costs they may experience in maintaining a transformed PCMH practice.

Public Health Relevance

The Patient-Centered Medical Home (PCMH) model is expected to help achieve the triple aims of improving the patient experience of care, improving the health of populations, and reducing the cost of care. Understanding the cost to a primary care practice to deliver services in a PCMH model is essential to supporting the required investment in infrastructure. The proposed research will identify these costs in a variety of practices, providing future guidance to practices, payers, and policy makers.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Special Emphasis Panel (ZHS1-HSR-O (01))
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Mcnellis, Robert
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University of Utah
Family Medicine
Schools of Medicine
Salt Lake City
United States
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Magill, Michael K; Ehrenberger, David; Scammon, Debra L et al. (2015) The cost of sustaining a patient-centered medical home: experience from 2 states. Ann Fam Med 13:429-35