Project ECHO

At a Glance

National Office: 
University of New Mexico School of Medicine MSC07 4245 1 University of New Mexico
Albuquerque, NM 87131

Sanjeev Arora
People Served: 
10,000,000
Tax ID: 
85-0275408

Focus area(s):

Health Services/Access

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Description

Project ECHO® is a disruptive innovation that dramatically improves both capacity and access to specialty care for rural and underserved populations. This low-cost, high-impact intervention is accomplished by linking expert interdisciplinary specialist teams with primary care clinicians, community health workers (CHWs), nurses, and other healthcare professionals through teleECHO™ clinics, in which the experts co-manage patient cases and share their expertise via mentoring, guidance, feedback and didactic education.  This effectually demonopolizes specialty knowledge by enabling primary care clinicians and other healthcare professionals to develop the skills, knowledge and self-efficacy to treat patients with common, complex diseases in their own communities in turn reducing travel costs, wait times, and avoidable complications.  Internal and external stakeholders agree that ECHO has the potential to transform healthcare delivery in the U.S. and globally. In addition to using the ECHO model to improve healthcare, the model has also been applied to education, where it is being used to train teachers about assistive technologies to aid students with learning disabilities, and in quality improvement to aid clinics in improving patient flow.  While most of the ECHO Institute’s work to date has focused on healthcare, the model has tremendous applications for improving a variety of disciplines wherever there is a need for the right knowledge at the right place and the ability to connect experts and learners virtually.

Impact and Outcomes

Access to specialty healthcare
Expanded delivery of evidence-based best practice care
A new paradigm for team-based interdisciplinary professional development.

Mission & Goals

The mission of Project ECHO (Extension for Community Healthcare Outcomes) is to develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas, and to monitor outcomes of this treatment.  Currently thousands of clinicians and hundreds of thousands of patients benefit from ECHO—at full scale, millions will. Project ECHO strives to positively affect the lives of one billion people by the year 2025. 

Program

The ECHO model™, created as a platform for both healthcare service delivery and research in June 2003, breaks down the walls between specialty and primary care and helps to deliver the right knowledge at the right place and time.  The model links expert specialist teams at an academic “hub” with primary care clinicians in local communities – the “spokes” of the model.  Together, they participate in weekly teleECHO™ sessions, which are similar to virtual grand rounds, combined with mentoring and patient case presentations.  The clinics are supported by basic, widely available teleconferencing technology. During teleECHO clinics, primary care clinicians from multiple sites present patient cases to the specialist teams and to each other, discuss new developments relating to their patients, and discuss treatment recommendations. 

 

Specialists serve as mentors and colleagues, sharing their medical knowledge and expertise with primary care clinicians.  Essentially, the ECHO model creates ongoing learning communities where primary care clinicians and other healthcare professionals receive support and develop the skills they need to treat a particular conditions.  As a result, they can provide comprehensive, best-practice care to patients with complex health conditions, right where they live.

The ECHO model is not “telemedicine” where the specialist assumes the care of the patient, but instead a guided practice model where the primary care clinician retains responsibility for managing the patient, operating with increasing independence as their skills and self-efficacy grow.

KEY ELEMENTS OF THE ECHO MODEL

1.       Multipoint videoconferencing technology to connect a multidisciplinary team of experts with learners at spoke sites, leveraging scarce healthcare resources.

2.       Disease management model with a focus on improving outcomes by reducing variation in processes of care and sharing best practices, including use of algorithms, checklists, and chronic care teams.

3.       Case-based learning.

4.       HIPAA compliant online database to monitor outcomes.

Impact

From 2003 to 2011, the effectiveness of the ECHO model™ was evaluated by assessing the impact on rural clinicians participating in teleECHO clinics. Impact measurements included effect on treatment rates, self-efficacy and overall professional satisfaction.  The results of this research were first published in Hepatology in September 2010.  This article illustrated the ECHO model’s impact to the current healthcare system in three major areas: 1) access to specialty healthcare, 2) expanded delivery of evidence-based best practice care, and 3) a new paradigm for team based interdisciplinary professional development. •    Patient outcomes were evaluated via a prospective cohort study funded by the federal Agency for Healthcare Research and Quality (AHRQ) and published in the New England Journal of Medicine in June 2011.  The study compared treatment of hepatitis C (HCV) at the University of New Mexico Health Sciences Center (UNMHSCHCV Clinic to treatment by primary care clinicians at Project ECHO partner sites in rural New Mexico. The study showed that HCV care provided by ECHO trained clinicians was as safe and effective as the care provided by university-based specialists, and that access for minorities was greatly increased through the ECHO model.

Since then, there have been more than 50 studies published about the ECHO model (See: http://echo.unm.edu/about-echo/research/).  

Growth Plan

In addition to the 90 existing hubs in 16 countries, agreements are currently in place with more than 200 additional replication partners (many of them Academic Medical Centers) to be launched as ECHO hubs. 

ECHO’s four-year growth strategy calls for developing and supporting over 200 hubs, training thousands of clinicians and improving the health and well-being of hundreds of thousands of patients. This will be achieved through the following mechanisms:
o    Provide replication training and support services to the new hubs, and additional ongoing technical assistance to hubs on request.
o    Train regional training or “super” hubs that will develop the capacity to train and support new hubs in other areas of the world as the replication office in New Mexico currently does.
o    Build the capacity to collect, aggregate, and analyze data submitted from the partner hubs, allowing for refinement of the model, continuous quality improvement, research, and the “big data” strategy that will eventually become a major source of revenue for ECHO.
o    Promote the ECHO model and its adoption among state payers, government agencies, and private payers.
 

Location of Sites

National Office: 
University of New Mexico School of Medicine MSC07 4245 1 University of New Mexico
Albuquerque, NM 87131
List of locations

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Locations in the following states:

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Financials

Most Recent Budget

REVENUE

Corporate Grants: 
$0
Foundation Grants: 
$8,190,864
Government Funding: 
$1,482,622
Contributions from Individuals: 
$0
Special Events: 
$0
Program Services Fees: 
$0
Membership Dues: 
$0
Other Earned Income: 
$0
Other Revenue: 
$0
Total Revenue: 
$9,673,486

EXPENSES

Salaries, Related Salaries & Professional Fees: 
$4,205,719
Occupancy: 
$0
Travel & Entertainment: 
$92,023
Office Supplies, Printing, Postage: 
$171,010
Telephone & Communications: 
$40,448
Payments to Affiliates: 
$0
Other Expenses: 
$5,164,286
Other Expenses (Description): 

Other Expenses (Description): 

Total Expenses: 
$9,673,486

NET GAIN/LOSS

Net Gain/Loss: 
$0

Prior Year Actuals

REVENUE

Corporate Grants: 
$0
Foundation Grants: 
$2,945,825
Government Funding: 
$966,900
Contributions from Individuals: 
$0
Program Services Fees: 
$535,227
Membership Dues: 
$0
Other Earned Income: 
$0
Other Revenue: 
$35,250
Special Events: 
$0
Total Revenue: 
$4,483,202

EXPENSES

Salaries, Related Salaries & Professional Fees: 
$3,247,769
Occupancy: 
$0
Travel & Entertainment: 
$79,057
Office Supplies, Printing, Postage: 
$103,661
Telephone & Communication: 
$40,649
Payments to Affiliates: 
$0
Other Expenses: 
$1,635,857
Other Expenses (Description): 

Total Expenses: 
$5,106,993

NET GAIN/LOSS

Net Gain / Loss: 
$-623,791

Major Funders

Bristol-Myers Squibb Foundation

CDC Foundation

Centers for Medicare and Medicaid Services

Defense Health Administration

GE Foundation
Leona M. and Harry B. Helmsley Charitable Trust
 

Merck Foundation

New Mexico Legislature
Robert Wood Johnson Foundation