“It's a brand-new model for continuing education,” says Arora, director of Project ECHO. “We think it's one of the best models. It's case-based learning and really improves quality of care,” he says, adding that in New Mexico, Project ECHO has provided about 57,000 hours in continuing medical education for healthcare clinicians in the past 10 years.
Clinicians who provide the training are not compensated on a fee-for-service basis, according to Arora, who says Project ECHO will typically pay the clinician's respective medical center for his or her time. Arora says he's trying to build relationships with commercial insurers that, in turn, would cover part of the specialists' salaries to provide the consultation.
The model has already been replicated at other academic medical centers in the U.S., including the University of Washington, University of Chicago, Beth Israel Deaconess Medical Center, the University of Utah and the University of South Florida, and others are in the planning stages.
The CMS Center for Medicare & Medicaid Innovation awarded Project ECHO a three-year $8.5 million healthcare innovation grant. Meanwhile, this summer, the Robert Wood Johnson Foundation provided $5 million in funding to establish the new Project ECHO Institute through 2016. That grant money is to be used for replicating the model within the U.S., and Arora says he is currently looking for funding to expand it internationally.
Launched in 2003, Project ECHO uses “telementoring” to train primary-care providers on how to treat chronic conditions such as hepatitis C, asthma, diabetes, mental illness and pain issues.
“The treatment of hepatitis C has been changing, so it's hard to keep up with the best treatment and safety of medications,” says Dr. Shobha Joshi, director of hepatology research at Ochsner Health System in New Orleans, which is working to replicate Project ECHO to serve remote areas of Louisiana. “All of that requires a lot more expertise than what a small rural provider site can do—whether they're clinics, small hospitals or private practitioners who treat these patients.”
When the findings of a Project ECHO evaluation were published in the New England Journal of Medicine two years ago, Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said the model has the “potential to transform healthcare as we know it,” and that what began as a “truly disruptive innovation in New Mexico for treatment of hepatitis C has the capacity to re-engineer healthcare delivery and training across the healthcare system.”
In addition to Ochsner in New Orleans, the University of Texas MD Anderson Cancer Center in Houston also has expressed interest in copying the model. Arora says he expects representatives from MD Anderson to visit the institute for an orientation this fall, and clinicians from Ochsner visited this summer.
Joshi was one of the Louisiana health system's two representatives to attend a one-day orientation at the University of New Mexico in July. She says the day included presentations from speakers about how the model can help providers and patients in rural communities. And the conference also showed attendees how to set up “teleECHO,” which she describes as the video conferencing capability between the “hub”—in her case, Ochsner—and participating clinics. There also was a two-hour hepatitis C treatment consultation, where she could see about 10 to 12 other sites participating.
“It helps providers learn how to take care of these patients and provide good advice,” says Joshi, who adds that she expects it will cost Ochsner about $15,000 for a one-time setup of the large screens and video-conferencing capabilities to serve as the hub site. The individual providers in outlying communities will need only a laptop and video camera, and it's free for them to participate.