Project ECHO Uses Telehealth to Improve Population Health: What’s Next for States?

March 07, 2018|5:14 p.m.| Emily Moore

Project ECHO (Extension for Community Healthcare Outcomes) is a virtual learning and training model that uses video teleconferencing to enable access to high-quality healthcare for underserved people all over the world. Founded at the University of New Mexico, Project ECHO’s goal is to touch the lives of one billion people by 2025.

For each Project ECHO program, an expert team comprised of specialty care providers and other public health or healthcare practitioners holds weekly virtual sessions with community-based primary care clinicians. During these sessions, the community practitioners present real anonymized patient cases to the expert team. Then, the group collectively discusses the most appropriate treatment, allowing for the exchange of medical knowledge and expertise. Project ECHO supports training for more than 65 complex conditions, including HIV, tuberculosis (TB), chronic pain, endocrinology, behavioral health disorders, and many others.

To date, Project ECHO is making great strides toward achieving its 2025 goal by establishing 10 superhubs, 107 hubs, and seven U.S. Department of Defense and nine U.S. Department of Veterans Affairs hubs across 23 countries.

Founder and director of Project ECHO, Sanjeev Arora, MD, spoke at the 2017 ASTHO Annual Meeting to share information about the model and discuss how public health practitioners can use this model to improve health outcomes, particularly for rural and underserved populations. Project ECHO approaches chronic disease treatment as a “team sport” in that it recognizes the need to train community health workers (CHWs), nurses, and other members of the primary care team in preventing, identifying, and managing common chronic conditions. As such, Project ECHO also offers CHW training and ongoing support and training for specific diseases and populations.  In his remarks, Arora called Project ECHO a force multiplier because it supports community clinicians’ reach and furthers their expertise in their practice. In fact, several state health agencies are currently using Project ECHO to expand their reach into communities and engaging healthcare providers, CHWs, and other team members to improve population health.

Sanjeev Arora, MD at 2017 ASTHO Annual meeting
Sanjeev Arora, MD, speaks
about Project ECHO at the
2017 ASTHO Annual Meeting.

Pioneering Project ECHO in New Mexico Benefits Prisons and Rural Populations 

The New Mexico Department of Health (NMDOH) works with Project ECHO to facilitate training on several public health issues, including hepatitis C, antimicrobial stewardship, TB, reproductive health, and emerging infections (e.g., Zika and Ebola). For each of these programs, NMDOH staff members (e.g., a program manager, nurse consultant, and/or medical director) participate as part of the expert ECHO team, in addition to University of New Mexico clinical providers and Project ECHO staff. These Project ECHO programs bolster current NMDOH projects and available training for clinical providers, increasing the impact and reach of NMDOH’s training and outreach efforts with healthcare providers across the state, particularly in rural areas.

Lynn Gallagher, cabinet secretary of NMDOH, shared that New Mexico faces significant health disparities and impediments to delivering services in rural and frontier areas, making Project ECHO a critical component of NMDOH’s work. In her experience, the Project ECHO model breaks down walls between stakeholders, addresses barriers, and utilizes economical and widely accessible technology to connect specialty care to primary care to address health disparities for minority and rural populations. Further, this model has allowed NMDOH to focus on chronic disease prevention and treatment in a more strategic way and work with ECHO partners on improving data collection, understanding providers’ coverage and reimbursement challenges for evidence-based services, and recruiting and training providers in public health approaches. As state and territorial health officials consider the merits of Project ECHO, Gallagher recommends prioritizing conditions that will have the biggest impact on their jurisdiction’s needs.

Beyond the conditions listed above, NMDOH and the New Mexico Corrections Department partnered to support the New Mexico Peer Education Project, a prison-based peer education program to increase knowledge of key health issues, improve health literacy, and reduce risky behaviors. Inmates become peer educators after successfully completing 40-hour trainings on health topics (e.g., hepatitis C, HIV, sexually transmitted infections, etc.), techniques (e.g., motivational interviewing and behavioral change), and skill building (e.g., public speaking and group facilitation), and then they conduct workshops with their peers. Project ECHO then serves as a reference for peer educators as they pursue future job opportunities and look for ways to serve their communities after incarceration. Thus, NMDOH’s work with Project ECHO demonstrates effectiveness beyond clinical-focused models by training peer educators, which can improve health literacy and address the needs of justice-involved individuals who often have significant physical and behavioral health needs and face barriers in accessing care and finding jobs following release.

More State Health Agencies are Collaborating with Project ECHO 

While New Mexico is leading the way with Project ECHO, other state and territorial health agencies are also looking to Project ECHO to help improve health outcomes in the communities they serve. For example, the Hawaii State Department of Health provided initial start-up funding and resources for the Project ECHO in Hawaii hosted by the Hawaii State Rural Health Association. The Washington State Department of Health supports a Project ECHO for TB. The Virginia Department of Health is developing a statewide Project ECHO to help build the capacity of providers in the state to provide medication assisted treatment and addiction disease management to patients, as part of its response to the opioid misuse epidemic.

Virginia is not alone: at least 20 states receiving funding from the CURES Act plan to implement an opioid ECHO to address this public health crisis. In fact, states were inspired by success in New Mexico where, after the start of the addictions teleECHO clinic, the cumulative number of buprenorphine-waivered physicians who can provide medication-assisted treatment in underserved regions in New Mexico increased dramatically, far outpacing other states.

Arora suggested several opportunities for state and territorial health agencies to use Project ECHO to advance population health, including working with native populations, improving nursing home care, improving care for sexually transmitted infections and emerging diseases, and supporting training, mentoring, and program coordination for public health practitioners and other diverse stakeholders.

Learn more about Project ECHO and view related resources from ASTHO, including the 2017 Telehealth Resource Guide with examples of Project ECHO and other telehealth programs in states with links to key policy and programmatic resources. ASTHO is interested in supporting state and territorial health agencies in leveraging Project ECHO and learning more from those who have participated in Project ECHO. If you are interested in sharing your work, please contact Emily Moore, ASTHO’s director for clinical to community connections.

Emily Moore

Emily Moore is director for clinical to community connections at ASTHO, where she helps manage ASTHO’s work on payment and delivery reform, developing cross-sector partnerships to advance population health, and innovations in care delivery. As part of this work, she leads ASTHO’s portfolio in telehealth.