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How Project ECHO Will Advance Rural Health through Telehealth

The Project ECHO Act plans to bring much-needed resources to rural health providers by using telehealth to connect them with their peers.

By Sheri Stoltenberg

- As we leave 2016 behind and celebrate the New Year, we are seeing continued progress for telehealth and rural health initiatives.

Project ECHO, telehealth, and rural health

One of the biggest milestones is Congress’ passing of the bipartisan, bicameral bill S. 2873 (the counterpart to H.R. 5395), the Expanding Capacity for Health Outcomes (ECHO) Act, which extends Project ECHO nationwide.

Project ECHO provides professional development services to remote and rural health providers. The new legislation calls for pairing academic specialists with primary-care providers through the use of virtual clinics designed to mentor providers, while addressing behavioral and public health needs. In doing so, Project ECHO also aims to reduce providers’ sense of isolation by architecting a network of support.

The bill, which is now awaiting signature by President Obama, was originally introduced by Senators Orrin Hatch and Brian Schatz, followed up with introductions in the House by Congressman Michael C. Brugess and Congresswoman Doris Matsui.

“In Sacramento, we’ve seen how the Project ECHO model can harness the power of technology to bring specialty expertise to community health centers and other providers in underserved areas,” Matsui stated, addressing the impact and expansion of the model for care beyond its origin.

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“By passing the ECHO Act, communities across the country will now be able to benefit from this successful model to better serve patients in areas such as pain management and addiction.”

By taking a closer look at the project’s implementation, expansion, and focus, we can have a better understanding of how and why it works.

The launch and significance of Project ECHO

As Project ECHO expands its impact nationwide, it’s mindboggling to consider that it was once such a small and contained project.

Founded by Sanjeev Arora, MD, professor of Internal Medicine at the University of New Mexico, Project ECHO commenced as a clinic to treat thousands of underserved hepatitis C patients. The ECHO Model launched in 2003 as a collaboration between teams of specialists at academic medical centers with local clinicians to expand treatment knowledge and capability.

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The disease management program was so successful that it caught on quickly, and today, has been implemented by 103 partners with more than 6,000 patients enrolled. Twenty-four clinics in New Mexico now offer hepatitis C treatment through the program, up from just two before the initiative began.

The reason behind the fast growth since its inception is due to the concept being simple, cost-effective, and outcomes-driven: to use technology to connect academic experts with clinicians throughout the country — especially in rural or underserved areas. By doing this, a greater number of high-needs patients can receive treatments based on the most up-to-date, and best, practices.

The ECHO model addresses areas of critical need

The program initially focused on hepatitis C treatment in New Mexico, but today focuses on multiple diseases and high-need aspects of care throughout the country and even internationally.

In clinical pediatrics, for example, the ECHO Model has been used to train primary-care providers in best practices for autism spectrum disorder (ASD) patients with the use of biweekly clinics. ECHO Autism led to improved adherence to ASD screening guidelines and use of resources with higher participant satisfaction compared with traditional care models.

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In Washington, community practitioners with the goal of improving HIV care capacity took part in a distance mentorship and consultation program, based on Project ECHO, and experienced similarly positive results.

The telehealth tools derived from the ECHO-based program decreased provider isolation while significantly increasing provider confidence in HIV care. Providers also reported a stronger feeling of professional connectedness. Extending into veterans care, the Veterans Health Administration (VHA) created the SCAN-ECHO “telementoring" program for pain management across seven healthcare networks.

A separate ECHO Model program centered on women’s health, Bone Health ECHO focused on the management of osteoporosis and metabolic bone disease by utilizing best practices derived from a knowledge network of tele-connected academic specialty-care experts and primary-care providers.

Moving into rural domains

The ECHO Act’s most recent progress was reported shortly after federal grants were announced for rural healthcare providers to address their specific needs. Benefiting 10 rural Montana, Nevada and North Dakota hospitals, CMS’ Frontier Community Health Integration (FCHI) project demonstration is rolling out new integrated healthcare models in sparse or isolated rural areas.

Under the program, participating providers are offered increased reimbursement to cover new services such as telemedicine and skilled nursing care, which hospitals will provide to make care access more convenient to patient populations.

Rural healthcare aid doesn’t end there. Recently, the Health Resources and Services Administration (HRSA) allocated more than $16 million toward telehealth and quality improvement initiatives, benefitting 60 rural communities within 32 states.

As we move into 2017, we expect initiatives like Project ECHO to increase the adoption of telemedicine, and strengthen medical organizations in rural areas.

Through today’s rural health initiatives, healthcare providers across the country can overcome miles of physical isolation through the utilization of telehealth, mentorship and collaboration projects.

And in doing so, they'll have better opportunities for financial reimbursement, improved population health treatment and a more educated pool of connected community-care providers.


Sheri Stoltenberg is founder and CEO at Stoltenberg Consulting

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