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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

Abstract

Background

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.

Aim

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.

Setting

Weekly group videoconferencing sessions that connect multidisciplinary specialists with OITs.

Participants

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.

Discussion

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

KEY WORDS

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

Notes

Acknowledgments

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.

Disclaimer

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)

References

  1. 1.
    Hamblin A, Somers SA. Introduction to Medicaid Care Management Best Practices. Hamilton, NJ: Center for Health Care Strategies, Inc.; 2011. Retrieved from: https://www.chcs.org/resource/introduction-to-medicaid-care-management-best-practices/ on 20 Mar 2019.Google Scholar
  2. 2.
    Hochman M, Asch SM. Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations. J Gen Intern Med 2017;32(4):392–397.  https://doi.org/10.1007/s11606-016-3945-2 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Blumenthal D, Chernof B, Fulmer T, Lumpkin J, Selberg J. Caring for High-Need, High-Cost Patients — An Urgent Priority. N Engl J Med 2016;375(10):909–911.  https://doi.org/10.1056/NEJMp1608511 CrossRefPubMedGoogle Scholar
  4. 4.
    Bodenheimer T. Strategies to Reduce Costs and Improve Care for High-Utilizing Medicaid Patients: Reflections on Pioneering Programs. Center for Health Care Strategies; 2013:1–24. http://www.chcs.org/media/HighUtilizerReport_102413_Final3.pdf. Retrieved on 5 May 2017.
  5. 5.
    Rich E, Lipson D, Libersky J, Parchman M. Coordinating Care for Adults with Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions. Rockville, MD: Agency for Healthcare Research and Quality; 2012. https://pcmh.ahrq.gov/sites/default/files/attachments/coordinating-care-for-adults-with-complex-care-needs-white-paper.pdf. Retrieved on 5 March 2018.Google Scholar
  6. 6.
    Loeb DF, Bayliss EA, Binswanger IA, Candrian C, deGruy FV. Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness. J Gen Intern Med 2012;27(8):945–952.  https://doi.org/10.1007/s11606-012-2005-9 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Loeb DF, Bayliss EA, Candrian C, deGruy FV, Binswanger IA. Primary care providers’ experiences caring for complex patients in primary care: a qualitative study. BMC Fam Pract 2016;17.  https://doi.org/10.1186/s12875-016-0433-z
  8. 8.
    Fiscella K, Epstein RM. So Much to Do, So Little Time: Care for the Socially Disadvantaged and the 15-Minute Visit. Arch Intern Med 2008;168(17):1843–1852.  https://doi.org/10.1001/archinte.168.17.1843 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Health Care’s Blind Side: Unmet Social Needs Leading To Worse Health. RWJF. https://www.rwjf.org/en/library/articles-and-news/2011/12/health-cares-blind-side-unmet-social-needs-leading-to-worse-heal.html. Published December 7, 2011. Retrieved on 13 Nov 2018.
  10. 10.
    Arora S, Kalishman S, Dion D, et al. Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care. Health Aff (Millwood) 2011;30(6):1176–1184.  https://doi.org/10.1377/hlthaff.2011.0278 CrossRefGoogle Scholar
  11. 11.
    Arora S, Kalishman S, Dion D, et al. Knowledge Networks for Treating Complex Diseases in Remote, Rural, and Underserved Communities. In: Mc Kee A, Eraut M, eds. Learning Trajectories, Innovation and Identity for Professional Development. Dordrecht: Springer Netherlands; 2012:47–70.  https://doi.org/10.1007/978-94-007-1724-4_3 CrossRefGoogle Scholar
  12. 12.
    Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med 2011;364(23):2199–2207. http://www.nejm.org/doi/full/10.1056/Nejmoa1009370. Accessed 18 Apr 2017.CrossRefGoogle Scholar
  13. 13.
    Komaromy M, Duhigg D, Metcalf A, et al. Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders. Subst Abus 2016;37(1):20–24.  https://doi.org/10.1080/08897077.2015.1129388 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Katzman JG, Comerci G, Boyle JF, et al. Innovative Telementoring for Pain Management: Project ECHO Pain. J Contin Educ Heal Prof 2014;34(1):68–75.  https://doi.org/10.1002/chp.21210 CrossRefGoogle Scholar
  15. 15.
    Hong CS, Siegel AL, Ferris TG. Caring for high-need, high-cost patients: what makes for a successful care management program. Issue Brief (Commonw Fund). 2014;19(1):9. https://www.communitycarenc.org/elements/media/publications/caring-for-high-need-high-cost-patients-what-makes.pdf. Accessed 8 May 2017.Google Scholar
  16. 16.
    Bates DW, Saria S, Ohno-Machado L, Shah A, Escobar G. Big Data In Health Care: Using Analytics To Identify And Manage High-Risk And High-Cost Patients. Health Aff (Millwood) 2014;33(7):1123–1131.  https://doi.org/10.1377/hlthaff.2014.0041 CrossRefGoogle Scholar
  17. 17.
    Raven MC, Kushel M, Ko MJ, Penko J, Bindman AB. The Effectiveness of Emergency Department Visit Reduction Programs: A Systematic Review. Ann Emerg Med 2016;68(4):467–483.e15.  https://doi.org/10.1016/j.annemergmed.2016.04.015 CrossRefPubMedGoogle Scholar
  18. 18.
    Davis R. Using a Cost and Utilization Lens to Evaluate Programs Serving Complex Populations: Benefits and Limitations. Center for Health Care Strategies, Inc.; 2017. https://www.chcs.org/resource/using-cost-utilization-lens-evaluate-programs-serving-complex-populations-benefits-limitations/. Accessed 30 Mar 2018.
  19. 19.
    Komaromy M, Bartlett J, Zurawski A, et al. A Novel Intervention for High-Need, High-Cost Medicaid Patients: A Study of ECHO Care. J Gen Intern Med. 2018;Under revision.Google Scholar
  20. 20.
    Clarke JL, Bourn S, Skoufalos A, Beck EH, Castillo DJ. An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions. Popul Health Manag 2017;20(1):23–30.  https://doi.org/10.1089/pop.2016.0076 CrossRefPubMedPubMedCentralGoogle Scholar

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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