Even with the Affordable Care Act, millions of Americans struggle to access health care when they need it. A huge part of the problem is a lack of both primary care and specialty providers in rural and other underserved communities. Without local providers who can meet patients’ needs, health care coverage does not necessarily translate to access to care.
Developing Health U.S., the GE Foundation’s signature health program, strives to help as many people as possible gain access to health care by partnering with community health centers around the country. Community health centers are the backbone of the health care safety net, providing affordable primary care services to millions of uninsured and working poor Americans.
Over the years, we have worked with more than 160 community health centers in forty-two cities in an effort to improve follow-up care, reduce patient wait times, improve access to behavioral health services, and increase the numbers of patients who keep their medical appointments. (Click on this link and then click on the “Capacity Building” box to read about some examples of successes.)
We have learned a great deal from these efforts. What they highlight for us, more than anything, is the tremendous ability of properly supported community providers to do more for underserved populations.
So, we are now embarking on an ambitious new strategy to support community providers by connecting them to a transformative model of medical knowledge-sharing and collaborative practice called Project ECHO (Extension for Community Healthcare Outcomes).
Origins of Project ECHO
Launched in 2003, Project ECHO grew out of one doctor’s vision. Sanjeev Arora, a liver disease specialist at the University of New Mexico Health Sciences Center in Albuquerque, was frustrated that he could serve only a fraction of the hepatitis C patients in that state who needed treatment. An estimated 36,000 New Mexicans had that disease, but only 5 percent were in treatment. In the entire state of New Mexico, just two clinics—Arora’s in Albuquerque and another in Santa Fe—had the necessary treatment expertise. New Mexico desperately needed more providers capable of managing hepatitis C in their local communities.
Accordingly, Arora created a free, virtual clinic to mentor community providers in how to treat hepatitis C. In Albuquerque, he assembled a multidisciplinary specialist team—including himself, a psychiatrist, a pharmacist, a nurse, and a social worker—to host weekly teleECHO clinics via videoconference for primary care providers from around the state.
Although the clinics featured brief lectures on hepatitis C management, the most important learning occurred when primary care providers presented their patients’ cases to the specialist team. During these “virtual clinical rounds,” Arora and his specialist colleagues worked with primary care providers to determine patient treatment—training them to manage a condition that previously was outside of their expertise.
After the first Hepatitis C TeleECHO Clinic launched, the wait time for hepatitis C treatment in New Mexico dropped from eight months to two weeks. More than 500,000 miles of patient treatment travel were avoided.
And the quality of care, as demonstrated in a study published in the New England Journal of Medicine, was excellent, as good as care provided in the university’s specialty clinic. That same study also showed that the ECHO model can reduce—and even eliminate—racial and ethnic disparities in treatment outcomes by bringing more services to minority communities. With Project ECHO, for the first time, patients with hepatitis C in New Mexico could get the high-quality treatment they needed from nearby providers.
With initial funding from the Agency for Healthcare Research and Quality (AHRQ) and with crucial support from the Robert Wood Johnson Foundation, the ECHO model has since expanded. Today, teleECHO clinics addressing dozens of common complex conditions take place every week—all following the model of the original Hepatitis C TeleECHO Clinic. Currently, more than fifty ECHO programs are running in ten countries across North and South America, Europe, and Asia. In the United States, primary care providers from every state have connected into a teleECHO clinic.
Launching a New Partnership
Now the GE Foundation is working to scale the model even further, with a new $14 million, three-year grant to Project ECHO to substantially increase the number of community health centers participating in ECHO nationwide.
Also under this grant, Project ECHO will partner with the Institute for Healthcare Improvement to design and implement a quality improvement program for Project ECHO. This program will support community health centers in improving effectiveness and efficiency.
We believe that community health centers are the key to improving health care access. They already do so much for so many people. By joining with Project ECHO, providers at community health centers helped by the foundation’s grant to Project ECHO will gain new knowledge and expertise to treat patients in their own communities. This empowerment creates what Arora calls a “force multiplier effect”—an exponential increase in workforce capacity.
The combined commitment and service of our nation’s community health centers with the ingenuity of the ECHO model will, we anticipate, drive extraordinary improvements in health care access and community health.
Related Health Affairs GrantWatch Blog content:
“Project ECHO GEMH: Disruptive Technology for Geriatric Mental Health,” by Brian Byrd and Bronwyn Starr of the New York State Health Foundation, May 28, 2015.
“Project ECHO Is Awarded $6.4 Million Grant For Diabetes And Endocrinology Care To New Mexico Underserved,” by Tracy Gnadinger, July 23, 2014.
“A Workforce That Can Do More: Project ECHO At Ten Years Brings Behavioral Health Care To Underserved Areas,” by John Lumpkin of the Robert Wood Johnson Foundation, July 8, 2013.
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