I met Sanjeev Arora as part of the RWJ crowd at TEDMED last year and was pretty impressed with his approach–especially given the lack of access to care in poor and minority regions. Now there’s proof his approach works –Matthew Holt
On June 1 the New England Journal of Medicine published a study about how primary care providers can treat very sick patients who previously did not have access to specialty care. The piece described Project ECHO, a disruptive model of health care delivery based on collaborative practice that has the potential to transform health care. Supported by Robert Wood Johnson’s Pioneer Portfolio and based at the University of New Mexico Health Sciences Center (UNMHSC), Project ECHO was developed by Sanjeev Arora, M.D., a hepatologist at UNMHSC and leading social innovator.
The ECHO model organizes community-based primary care clinicians into disease-specific knowledge networks that meet through weekly videoconferencing to present patient cases. These “virtual grand rounds” are led by specialists at academic medical centers who train providers to provide specialized care, share best practices and co-manage complex chronic illness care for patients with the local care team. Under this model, primary care providers treat patients in their own communities – burdens on academic center capacity are reduced, poor access to care is eliminated (patients are no longer limited by geography when seeking quality care), and the health care systems’ capacity to provide high quality care to more patients, sooner, is dramatically expanded.
In the NEJM study, patients with hepatitis C treated by primary care clinicians working through Project ECHO achieved results that were identical to patients treated by UNMHSC specialists. The evaluation also showed that the ECHO model can reduce racial and ethnic disparities in treatment outcomes.
Project ECHO offers promise as a game-changer for how patients with complex illnesses are treated. Dr. Arora describes the power of ECHO’s knowledge networks as a “force multiplier,” which “transforms the dynamics and the capacity of health care delivery and the spread of best practices.”
In an accompanying editorial, Thomas D. Sequist, M.D., associate professor of medicine and of health care policy at Harvard Medical School and Brigham and Women’s Hospital, said Project ECHO “represents an important step forward” in addressing barriers to accessing specialty care. He notes that the NEJM study raises several issues, including the need for adequate health information technology to implement the ECHO model successfully, the critical role of academic medical centers in supporting the model and the potential for meeting local community health care needs by extending the model to additional chronic diseases.
Sequist makes excellent points, and Project ECHO is already addressing them head-on.
The ECHO model harnesses communications technology to form truly collaborative provider partnerships that permit care in home communities. It connects the wealth of knowledge and expertise housed at academic medical centers and the desire of primary care providers to do more for their patients. And although the findings from the NEJM evaluation focus on hepatitis C, the Project ECHO model has spread to include asthma, mental illness, chronic pain, diabetes and cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology and substance abuse.
ECHO represents a fundamental rethinking of how we use our limited supply of physicians, how we engage a full care team in chronic disease management, how we teach best practices and how we provide access to quality care for all. We know we have physician shortages, an aging population and 32 million more Americans who are going to become insured in the coming years. Dr. Arora has developed a disruptive innovation that addresses these challenges.
Through ECHO, providers – not just doctors, but nurses, nurse practitioners, physician assistants and community health workers – are teamed to work together to the benefit of patients who receive accessible, high quality care.
Isn’t that what we all are striving to deliver?
Brian Quinn is the Pioneer Portfolio team leader, Robert Wood Johnson Foundation.