mHealth Intelligence: Senators Ask HHS to Sustain Project ECHO Telemedicine Programs

Nearly two dozen senators have asked HHS Secretary Alex Azar to find opportunities in existing Medicare and Medicaid policies to provide long-term sustainability for Project ECHO telemedicine programs.

Close to two dozen senators are urging the Health and Human Services Department to find sustainable funding for Project ECHO telemedicine programs.

In a letter to HHS Secretary Alex Azar, 22 senators urged the federal agency to issue CMS guidance to states and healthcare providers on available Medicaid financing for the innovative telehealth service, and to explore funding opportunities through existing Medicare programs.

They called the connected health platform a key cog in the framework of value-based care.

“Ultimately, as states and the federal government pursue delivery system reforms to achieve better patient outcomes and value, we recognize the need to improve access to high-quality, cost-effective specialty care,” the letter, dated Sept. 25, states. “Technology-enabled collaborative learning and capacity building models like Project ECHO move us closer to this shared objective, and they deserve our close attention and continued support.”

Launched in 2003 at the University of New Mexico School of Medicine by Sanjeev Arora, MD, a liver disease doctor based in Albuquerque who wanted to improve care management and coordination for patients with hepatitis C, Project ECHO (Extension for Community Health Outcomes) programs are now being deployed in 462 programs across 48 states, as well as several other countries.

The basic model places an academic medical center or large health system at the hub and provides telemedicine links to primary care providers, clinics and federally qualified health centers who participate in teleECHO clinics, which can take place weekly, bi-weekly or monthly. Through a secure teleconferencing platform, primary care providers present their patient cases for review by specialists, discuss new trends and techniques, and gather advice from their peers on how to treat their patients.

The model is now being used to address more than 70 complex chronic conditions, including substance abuse, pediatric care, behavioral health, diabetes care management and chronic pain.

“By leveraging multi-disciplinary teams of experts at academic medical centers to permanently enhance primary care capacity in local communities, Project ECHO expands specialty care access in rural and urban underserved areas, increasing the likelihood that patients get the care they need, when they need it, without having to rely on referrals and traveling long distances,” the letter states. “It can enable the more effective use of existing healthcare resources to achieve better outcomes, providing greater value to patients and taxpayers.”

But many programs face uncertain futures because they’ve been created through one-time grants or limited funds.

According to the letter, several states are looking for innovative ways to support the programs, but they don’t have a federal model or guidelines from which to work. Consequently, some states or health systems are steering clear of Project ECHO due to that uncertainty.

“Having CMS issue guidance on existing authorities that could be used under Medicaid would confirm that there are approvable models and clarify the steps for securing that approval, opening a pathway for states,” the letter says. It suggests a bulletin or State Medicaid Director’s Letter that addresses topics like capitation payments, disease management programs, health homes, Delivery System Reform Incentive Payment (DSRIP) programs, care coordination payments, episodes of care, network adequacy, value-added services and savings arrangements through accountable care organizations.

Likewise, the senators are asking HHS, through CMS, to explore how Project ECHO programs can be supported through Medicare, including the Merit-Based Incentive Payment System (MIPS) and shared quality goals. These programs might also qualify as “Improvement Activities,” by enhancing care coordination, patient and clinician shared decision-making and expansion of access.

“Allowing physicians to count ECHO activities in this category could encourage new providers to participate in ECHO and would help CMS achieve its quality goals,” the letter concludes.

Among those supporting the senators’ letter is Arora.

“We’re grateful for the bipartisan support from Congress for using technology enabled collaborative learning to get better care to people in rural and underserved parts of the country who need it most,” he said in a press release submitted by the New Mexico legislative delegation. “Guidance from CMS on financing strategies through Medicaid and Medicare will make it easier for states to start up or expand existing ECHO projects. It will help keep people in their communities getting good care from providers they know and trust.”

It’s not the first effort to secure funding for Project ECHO. This past May, Sens. Brian Schatz (D-HI), Tim Kaine (D-VA) and Lisa Murkowski (R-AK) introduced The Expanding Capacity for Health Outcomes Act of 2019 (ECHO 2019 Act), which calls on Congress to provide more funding for new and existing programs, to be used for digital health technology, support, training, data collection and evaluation.

“Technology has the potential to transform the way we train doctors and deliver health care,” Schatz, who sponsored a 2016 bill calling on HHS to study the Project ECHO model of care, said in a press release. “Our bill will provide new federal funding that will help connect primary care providers in medically underserved areas with specialists at academic hubs, making it easier for medical professionals to access the continuing education they need to provide high-quality health care to the people who need it most.”

In addition, the American Medical Association is supporting the model. At its annual meeting in June, the AMA adopted a policy to encourage implementation of both Project ECHO and Child Psychiatry Access Project (CPAP) programs by academic health centers and community-based primary care physicians.

“These training models offer a unique solution to specialty physician shortages by expanding the competencies and skills of physicians who are already providing patient care in our communities, rather than looking exclusively at increasing the physician workforce as the answer,” AMA Board Member S. Bobby Mukkamala, MD, said in an AMA press release. “The AMA supports multiple methods to help ease existing and predicted shortages, and we will continue to work toward ensuring more people have access to high quality health care.”

By:  Eric Wicklund
Source: mHealth Intelligence