By John Lumpkin, senior vice president and director of the health care group of The Robert Wood Johnson Foundation
Late last year, I had the opportunity to visit Project ECHO in Albuquerque, New Mexico. The timing seemed fortuitous. On the one hand, last November’s elections underscored all the challenges and unknowns surrounding implementation of the Affordable Care Act (ACA) and the future of our health care system. On the other hand, the progress and achievements of Project ECHO reminded me that, where there are problems, there are solutions as well.
In one transformative model, Project ECHO offers not only a new way of providing health care services and education but a new way of addressing a host of problems that have plagued our health care system for many years. These include continually escalating health care costs, inadequate access to care, serious shortfalls in quality of care, regional variations in how care is delivered, slow adoption of new medical knowledge and shortages of physicians, nurses, other primary care providers and specialists.
Although these problems may seem overwhelming, they don’t get me down. I am optimistic that they can be solved – and Project ECHO gives me even more cause for optimism. Project ECHO started in New Mexico, where it has been operating since 2003, focusing initially on management of hepatitis C. This year, the University of Washington launched an ECHO replication that is already catching on rapidly. I’m confident that Project ECHO can serve as a national model for health care delivery and continuing education. Consider the following:
We face a national problem with health care costs.
Project ECHO shows that we can do more – much more – with existing resources that are not being fully utilized: the expertise and knowledge housed at our academic medical centers, the desires of primary care providers in rural and underserved areas to better meet the needs of their populations, and the capacity of teletechnology to bridge these two health care settings and provide “health care without walls.”
We face a national problem with health care access and provider shortages.
By leveraging the capacities of our health care workforce more fully, Project ECHO shows how we can treat and manage chronic conditions in communities where such care previously was not available. Dr. Sanjeev Arora, the hepatologist who created Project ECHO, calls this the “force multiplier effect.” Project ECHO empowers primary care providers with new skill competencies, enables advanced practice nurses and physician assistants to work at the top of their education and training and supports the training and deployment of community health workers – doing more with our existing health care workforce.
We face a challenge in getting high-quality care distributed across the nation with reduced variability.
Project ECHO has demonstrated how to achieve improvements for evidence-based treatment and management of many chronic conditions, including hepatitis C, asthma and diabetes. Case-based learning through virtual knowledge networks supports real-time dissemination of best practice protocols that improves quality across the board.
We face serious challenges with physician retention in rural areas, where providers feel isolated and overwhelmed.
Project ECHO creates communities of health care professionals who learn and work together. Primary care providers in rural areas say they feel better equipped to address the health care needs of their communities, better supported and less susceptible to burnout.
I am particularly sensitive to the problems of rural communities, even though I was born, raised and educated in Chicago. “Rural” to me meant going out to the suburbs, until I was appointed to head up the Illinois Department of Public Health. I still remember when the stark realities and challenges of rural Illinois hit me. I had just joined the department when the Southern Medical Center in Cairo, Illinois, closed. Regardless of what kind of insurance you had, the closest hospital was still over 100 miles away. Specialty care required a very long trip to St. Louis or Indianapolis. I learned that access to care was as important as having health insurance to pay for it -- no, it was even more important.
Now, ironically, the University of Chicago is gearing up to launch an ECHO program that will manage heart disease among African American men. Access to care is a major problem not only in sparsely populated rural areas but also in some of our most densely populated urban neighborhoods where poverty and racial disparities are rife.
It’s true that our nation faces many challenges and many unknowns in implementing health reform. Project ECHO offers a model that, while elegant in its simplicity, is also utterly disruptive in its capacity to transform our health care system. Health care policymakers at various levels are starting to pay attention to what ECHO has to offer. Let’s hope that they continue to do so.
