Greg Howe

March 30, 2020

As Congress and the Department of Health and Human Services place increasing emphasis on the role of telehealth in the COVID-19 response, the predominant focus has been on provider-to-patient interactions. This is both necessary and important, but telehealth strategies can also enable critical provider capacity-building efforts that support rapid evolution of clinical protocols for testing and treatment. Telementoring — virtual collaborative learning and capacity building for providers — typically includes a multidisciplinary team of experts at one end and multiple teams of on-the-ground providers, often in rural and underserved communities, on the other end.

An Existing Telementoring Infrastructure

Real-time, regular communications channels between medical experts, public health officials, and front-line community providers ensures that information is flowing — in both directions — to share emerging learning and the most-current protocols for response. Project ECHO, launched in 2003 by the University of New Mexico’s School of Medicine, is a virtual telementoring model with more than 240 hubs— typically academic medical centers — operating in 48 states and reaching nearly 70,000 community providers. During this current crisis, it is absolutely critical that states and communities have opportunities to leverage existing national networks, like Project ECHO, particularly to reach rural and underserved communities around the country.

Project ECHO enhances workforce capacity in underserved areas by linking community-based primary care teams with evidence-based knowledge to manage patients with complex conditions. Each ECHO implementation functions as a hub-and-spoke model. The hub consists of a team of clinical experts — usually located in an academic medical center — that mentors participating primary care teams (spokes) to develop the competencies needed to effectively care for patients with specified needs independently and in their communities.

Leveraging Project ECHO in Response to COVID-19

Project ECHO is playing an important role in how health care providers, public health officials, and scientists in the United States and around the world are sharing best practices and information for addressing COVID-19.  Examples include:

  • The U.S. Centers for Disease Control and Prevention COVID-19 International Task Force conducted a 90-minute COVID-19 ECHO education session for the Department of Defense’s global HIV network of providers and their counterparts for 200 participants from over 30 countries. Participants included medical staff who support the public health response capabilities in the countries where they work.
  • Project ECHO supported a special COVID-19 Response ECHO for the entire Indian Health Service reaching clinical facilities from Alaska to Maine.
  • In New Mexico, the ECHO network across the state — which includes almost 10,000 health care workers — has now been activated around COVID-19 response. Topics include: treatment of COVID-19 in the hospitalized patient; infection control and COVID-19; how to best perform telephone triage for possible COVID-19 patients; and social isolation precautions to slow risk of transmission.
  • The Oregon ECHO Network, with support from the Oregon Health Authority, launched a COVID-19 ECHO to provide information on clinical management, testing, and community medical response. More than 700 health care clinicians participated in the first session, reaching providers in rural areas throughout the state.
  • Oklahoma State University, launched a COVID-19 ECHO that includes participants from the state hospital association, long-term care facilities, and the National Guard who meet virtually three times per week.
  • The Penn State Health System is running multiple ECHO sessions on a range of COVID-19-related topics for Pennsylvania providers throughout each week.
  • Other existing ECHO sites, such as those at the University of Chicago, are integrating COVID-19 training into existing programs focused on improving primary care capacity to treat an array of specialty conditions.
  • The Weitzman Institute is conducting a national COVID-19 ECHO for safety net providers focusing on emergency preparedness, operations, and clinical care. The Weitzman Institute based in Connecticut and part of Community Health Center, Inc., one of the largest community health center networks in the country, focuses on transforming the delivery of primary care through research, technology, education, and innovation.

Opportunities for State Medicaid Programs

There are Project ECHO hubs in 48 states, with some hubs reaching clinicians in multiple states. For example, the Idaho ECHO operates out of the University of Idaho in partnership with the University of Washington School of Medicine’s multi-state medical education program and serves Washington, Wyoming, Alaska, Montana, and Idaho. In light of the current, urgent need to bolster the ability of the health care work force, Medicaid agencies may consider the following opportunities to leverage federal matching funds to maximize the ECHO platform to support COVID-19 response efforts in their states:

  • Include Project ECHO in Section 1135 Waiver COVID-19 requests.  Under Section 1135 authority the Secretary of the U.S. Department of Health and Human Services (HHS) may temporarily waive certain statutes and regulations to allow states to respond to the COVID-19 national emergency. States may request HHS to allow them to use Medicaid funds for Project ECHO-supported efforts to build provider capacity to address COVID-19
  • Include Project ECHO in COVID-19: 1115 Waiver Demonstration requests.  HHS created a new Section 1115 waiver opportunity that provides states with additional authorities to help Medicaid agencies address the COVID-19 pandemic, retroactive to March 1. As part of an 1115 waiver application, states could request that HHS allow them to use Medicaid funds for Project ECHO-supported provider capacity-building efforts.

An Evolving Model to Address Current Challenges

CHCS aims to highlight innovative efforts, like Project ECHO, to support capacity-building efforts among health care providers to serve their patients and communities affected by COVID-19. CHCS will also promote considerations for state and other Medicaid stakeholders to maximize new funding and other administrative flexibilities to support their implementation. If you have examples to share or if you would like to discuss sample language for waiver submissions, please contact Greg Howe at ghowe@chcs.org.

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Barb Doty M.D.

WWAMI is a collaborative medical school among universities in five northwestern states, Washington, Wyoming, Alaska, Montana, and Idaho and the University of Washington School of Medicine. WWAMI Alaska, operating out of the University of Alaska Anchorage, would welcome exploring a partnership with Project ECHO, similar to WWAMI Idaho at the University of Idaho. WWAMI graduates 20 new Alaskan physicians each year with a payback obligation to return to Alaska practice with an overall 61% return rate.

Greg Howe, Center for Health Care Strategies

Thank you for your interest Barb. We’ll follow up with you by email. For others interested in learning more about joining Project ECHO, you can visit: https://echo.unm.edu/join-echo#learn