Journal of General Internal Medicine

, Volume 35, Issue 1, pp 326–330 | Cite as

ECHO Care: Providing Multidisciplinary Specialty Expertise to Support the Care of Complex Patients

  • Miriam KomaromyEmail author
  • Judy Bartlett
  • Andrea Zurawski
  • Sarah R. Gonzales-van Horn
  • Summers G. Kalishman
  • Venice Ceballos
  • Xi Sun
  • Martin Jurado
  • Sanjeev Arora
Innovation and Improvement: Innovations in Medical Education



Programs for high-need, high-cost (HNHC) patients can improve care and reduce costs. However, it may be challenging to implement these programs in rural and underserved areas, in part due to limited access to specialty consultation.


Evaluate the feasibility of using the Extension for Community Health Outcomes (ECHO) model to provide specialist input to outpatient intensivist teams (OITs) dedicated to caring for HNHC patients.


Weekly group videoconferencing sessions that connect multidisciplinary specialists with OITs.


Six OITs across New Mexico, typically consisting of a nurse practitioner or physician assistant, a registered nurse, a counselor or social worker, and at least one community health worker.

Program Description

OITs and specialists participated in weekly teleECHO sessions focused on providing the OITs with case-based mentoring and support.

Program Evaluation

OITs and specialists discussed 427 highly complex patient cases, many of which had social or behavioral health components to address. In 70% of presented cases, the teams changed their care plan for the patient, and 87% reported that they applied what they learned in hearing case presentations to other HNHC patients.


Pairing the ECHO model with intensive outpatient care is a feasible strategy to support OITs to provide high-quality care for HNHC patients.


ECHO model continuing medical education case-based learning complex care high-need, high-cost patients 



The authors would like to acknowledge Chris Ruge CNP, Devon Neale MD, and all OIT members and specialists; Jennifer Snead PhD, ECHO Institute; Mark Larson, Center for Healthcare Strategies; Nancy Smith Leslie, the NM State Medicaid Director; and the NM Medicaid MCOs.

Funding Information

This work was financially supported by the US Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (Grant Number 1C1CMS330973-01-00).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the US HHS or any of its agencies. The research presented was conducted by the awardee. Findings may or may not be consistent with or confirmed by the findings of the independent evaluation contractor.

Supplementary material

11606_2019_5205_MOESM1_ESM.docx (769 kb)
ESM 1 (DOCX 769 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Miriam Komaromy
    • 1
    Email author
  • Judy Bartlett
    • 2
  • Andrea Zurawski
    • 3
  • Sarah R. Gonzales-van Horn
    • 3
  • Summers G. Kalishman
    • 3
  • Venice Ceballos
    • 3
  • Xi Sun
    • 3
  • Martin Jurado
    • 3
  • Sanjeev Arora
    • 3
  1. 1.Grayken Center for Addiction Boston Medical CenterBoston UniversityBostonUSA
  2. 2.Department of Internal Medicine, Division of General Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueUSA
  3. 3.University of New Mexico Health Sciences Center, ECHO Institute™AlbuquerqueUSA

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