The Costs of Utilizing Nurse Care Managers for an OUD Treatment Model
Cost analysis informs budget and system-wide planning for expanding treatment for opioid use disorder (OUD) in primary care settings.
Medications for opioid use disorder (MOUD) are effective and safe but vastly underutilized by patients with OUD. Primary care settings offer a critical opportunity to expand access. In a JAMA Internal Medicine study, clinics that hired a dedicated nurse care manager to triage, assess, and coordinate care for patients with OUD saw a greater increase in MOUD treatment uptake. This care approach, known as the Massachusetts Model (MA Model), illustrates a promising strategy where nurses play a vital role in helping primary care clinics integrate OUD treatment more efficiently and effectively.
To inform healthcare managers and leaders about the financial resources needed to adopt and sustain the MA Model, Philip Jeng, research project manager at Weill Cornell Medicine, and colleagues conducted a micro-costing analysis to estimate the costs of implementing and sustaining the MA Model at six diverse health systems in the U.S. This economic analysis was conducted alongside the PRimary Care Opioid Use Disorders treatment (PROUD) implementation trial.
Published in the American Journal of Managed Care, the cost estimates for the MA Model were categorized as fixed start-up (one-time costs such as training), time-dependent (recurring costs such as rent and technical support meetings), or variable (resources utilized per patient contact such as provider time for care coordination), and were reported as annual per-clinic and per-patient costs for both the implementation and sustainment phases. Resources were identified and valued using semi-structured interviews and an activity-based costing approach. A budget impact tool was also developed to organize resources based on the needs of each phase.
Key Findings
- The average implementation cost was $238,888 per clinic or $3,185 per patient in Year 1.
- Variable costs accounted for two-thirds of implementation costs at $159,229 per clinic in Year 1. Variable costs were primarily associated with the time that nurse care managers spent on MA Model-related work which averaged 1,968 hours per year. Primary care providers, in contrast, spent significantly less time at 276 hours per year on average. This reflects the MA Model's core design, where nurse care managers drive care coordination while primary care providers focus on clinical oversight.
- Start-up and time-dependent costs were minimal. Mean one-time fixed start-up costs, largely related to training, were $9,2121 per clinic. Time-dependent costs, driven primarily by rent, were $70,446 per clinic.
Primary care clinics interested in adopting the MA Model to treat patients with OUD can use the study’s cost analysis and customizable budget impact tool to estimate their unique resource needs and the associated costs. While variable costs made up a significant proportion of expenses in Year 1 and subsequent years, authors note that they are easier to anticipate due to their linear and predictable marginal cost of expansion. The finding that nurse care managers absorbed the majority of patient-facing time also suggests that primary care providers can allocate more time to other clinical duties. In a forthcoming study, the research team will conduct a cost-effectiveness analysis of the MA Model to assess its economic value from both the healthcare sector and societal perspectives.
The study, “The Cost of Implementing and Sustaining the Massachusetts Model,” was published in The American Journal of Managed Care on April 22, 2026. Co-authors include CHERISH Co-director and senior author Sean M. Murphy, CHERISH Methodology Core Co-director Ali Jalali, and CHERISH Research Affiliates Kai Yeung and Thanh Lu.