The Department of Veterans Affairs (VA) today announced the formal launch of a new, transformative model of medical education and health care delivery that provides high-quality, complex care to veterans within the VA system, regardless of where they live.
The VA initiative, Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO), is the first nationwide implementation of Project ECHO. Sanjeev Arora, MD, a liver disease specialist and leading social innovator at the University of New Mexico Health Sciences Center (UNMHSC) in Albuquerque, created Project ECHO as a way to exponentially expand the health care system’s ability to treat patients with complex chronic illnesses.
The Robert Wood Johnson Foundation (RWJF) is supporting Project ECHO with a five-year grant that aims to expand the model across the United States.
“SCAN-ECHO is helping us to more fully harness the knowledge and expertise of our specialist physicians and extend that knowledge and expertise out into the field,” said Robert A. Petzel, MD, VA under secretary for health. “This model empowers our primary care doctors, nurses, and other clinicians, and it strengthens VA’s ability to serve our nation’s veterans.”
At a briefing held today at VA Central Office in Washington, D.C., to announce the SCAN-ECHO launch, John R. Lumpkin, MD, senior vice president and director of RWJF’s Health Care Group, noted that VA is the first health care system to embrace the ECHO model.
“This implementation of the ECHO model is a major step toward establishing it as a new norm for medical practice,” Lumpkin said. “Adopted widely, the ECHO model could help address some of the health care system’s most intractable problems, including access to care, workforce capacity, diffusion of best practices, and provider isolation.”
Eleven VA medical centers are currently serving as SCAN-ECHO centers (see attached list), piloting the original Project ECHO model across a range of chronic conditions and adapting it for use within VA, which operates the nation’s largest integrated health care system. VA will conduct an evaluation of the model’s impact on veterans’ access to care prior to system-wide expansion.
How the ECHO Model Works
The ECHO model links primary care providers in local communities with specialist care teams—often at academic medical centers—to manage patients who have chronic conditions requiring complex care. It uses videoconferencing technology to conduct weekly virtual clinics, which operate like the grand rounds major teaching hospitals use to educate doctors on the latest medical research and treatments.
During the clinics, primary care providers from multiple sites present their cases to the specialist teams, discuss new developments relating to their patients, and determine treatment. Specialists serve as mentors and colleagues, sharing their medical knowledge and expertise with primary care providers.
Primary care teams that participate in ECHO are part of an online learning community, where they develop the skills and receive the support they need to provide comprehensive, complex treatment for patients where they live. These teams become new, community-based centers of excellence.
Project ECHO is not traditional telemedicine that supports a one-to-one connection between a doctor and a patient. In fact, no patient is ever seen during an ECHO clinic. Instead, through Project ECHO, primary care clinicians learn to provide care that previously was not available in their communities.
“Project ECHO is a completely new way of sharing medical knowledge and providing medical care,” Arora said. “By making best practices and mentoring support widely available to primary care providers, it expands the health care system’s ability to provide care for very high-need patients. We call this the ‘force multiplier effect.’”
An evaluation funded by the federal Agency for Healthcare Research and Quality (AHRQ) and published in the New England Journal of Medicine showed that the quality of hepatitis C care provided by Project ECHO-trained clinicians was equal to that of care provided by university-based specialists.
“Project ECHO is an innovative approach to helping local providers deliver safe, high-quality care within their own—in most cases, underserved—communities,” said AHRQ Director Carolyn M. Clancy, MD. “The speed and enthusiasm with which VA has embraced the ECHO model demonstrates the need for practical, evidence-based solutions to our health care system’s most pressing challenges.”
VA’s Implementation of ECHO
A major focus of SCAN-ECHO is bringing complex specialty care to the millions of veterans who live in rural areas. Over the past year, Arora and his team have trained more than 120 VA physicians, nurses, and other primary care clinicians on using the ECHO model. Each SCAN-ECHO center conducts clinics in hepatitis C, as well as congestive heart failure, diabetes mellitus, or chronic pain management.
Although the VA is the first to implement the ECHO model on a national scale, other federal government agencies, academic medical centers, health plans, and health systems are already adopting the ECHO model. In June, Project ECHO signed an agreement with the Department of Defense to create a global chronic pain management program for the armed forces. In addition, RWJF is funding replication of the model in Washington state and Chicago.
In May, the U.S. Department of Health and Human Services announced the award of a three-year, $8.5 million Health Care Innovation grant for Project ECHO to expand its operations in New Mexico and Washington state.
- VA Connecticut Healthcare System, West Haven, Conn.
- VA Pittsburgh Healthcare System, Penn.
- Hunter Holmes McGuire VA Medical Center, Richmond, Va.
- Salem VA Medical Center, Salem, Va.
- Louis Stokes VA Medical Center, Cleveland, Ohio
- VA Ann Arbor Healthcare System, Ann Arbor, Mich.
- New Mexico VA Healthcare System, Albuquerque, N.M.
- VA Eastern Colorado Healthcare System, Denver, Colo.
- Portland VA Medical Center, Portland, Ore.
- San Francisco VA Medical Center, Calif.
- Veterans Integrated Service Network (VISN) 22 (services split between VA Greater Los Angeles Healthcare System and VA San Diego Healthcare System)
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