Table 2.
Transformation Components and Costs
| Transformation components | Transformation costs | ||||
|---|---|---|---|---|---|
| Proportion of practices participating in transformation activities | Major transformation activities | Costs per clinician, median (range) | Costs per patient, median (range) | Total costs per practice, median (range) | |
| One-time transformation activities | 100% (n = 10)† | - Prepare medical home infrastructure (e.g., setting up and verifying the accuracy of patient registries, employee training sessions to use quality reporting systems, preparing internal policies and procedures for medical home transformation, medical home recognition applications) (n = 10) - Upgrade EHR software (n = 4) |
$9814 ($1497–57,476) | $5 ($1–77) | $30,991 ($7694–117,810) |
| Ongoing transformation activities* | |||||
| Care management activities | 100% (n = 12) |
New staff hiring
- Care manager (n = 9, average of 0.87 FTEs per practice) - Other staff (e.g., medical assistant, nurse, social worker, pharmacist; n = 5, average of 0.98 FTEs per practice) New activities for current staff ‡ - Care management meetings (n = 5) - Patient outreach (e.g., appointment reminders, vaccination and routine test reminders; n = 5) - Hospital and emergency room transition phone calls (n = 3) - Patient education (e.g., self-management of chronic diseases; n = 2) |
$29,457 ($11,420–78,182) | $16 ($3–110) | $113,031 ($41,191–234,547) |
| General QI activities | 92% (n = 11) | - Quality measurement, reporting, and tracking (n = 10) - Physician care reminders (n = 8) - Team meetings (n = 6) |
All practices:
$5765 ($0–29,924) Among those making investment: $6390 ($1250–29,924) |
All practices:
$3 ($0–26) Among those making investment: $4 ($1–26) |
All practices:
$23,734 ($0–63,905) Among those making investment: $29,994 ($2500–63,905) |
| Expanded access | 33% (n = 4) | - Increased office hours (n = 3) |
All practices:
$0.00 ($0–28,151) Among those making investment: $26,637 ($2382–28,151) |
All practices:
$0 ($0–18) Among those making investment: $14 ($1–18) |
All practices:
$0 ($0–168,905) Among those making investment: $79,561 ($11,910–168,905) |
| Expanding IT | 33% (n = 4) | -Yearly maintenance and updates of EHRs§ (n = 4) |
All practices:
$0 ($0–20,069) Among those making investment: $3339 ($173–20,069) |
All practices:
$0 ($0–10) Among those making investment: $7 ($4–10) |
All practices:
$0 ($0–40,138) Among those making investment: $19,190 ($1733–40,138) |
| Other costs | 42% (n = 5) | - Hire other staff (e.g., consultants, accounting services, increasing physician work hours; n = 3, average of 0.55 FTEs) - Staff training (n = 2) |
All practices:
$0 ($0–55,467) Among those making investment: $2459 ($601–55,467) |
All practices:
$0 ($0–22) Among those making investment: $2 ($1–22) |
All practices:
$0 ($0–83,200) Among those making investment: $9000 ($6013–83,200) |
| Total Median Yearly Ongoing Costs ‖ | $64,768 ($18,585–93,856) | $30 ($8–135) | $147,573 ($83,829–346,603) | ||
*Ongoing costs were measured on a yearly basis
†We were unable to collect one-time activities for two of the practices
‡For practices that hired care managers, these new staff members performed many of these same activities. Therefore, activities performed by newly hired care managers were “rolled into” the care manager hiring
§We were unable to collect IT-related costs for some system-affiliated practices because these costs were incurred at a higher organizational level
‖ This median does not represent the sum of categories above