Project ECHO is a telehealth mentoring program that enhances workforce capacity in underserved areas by providing community-based primary care providers with the knowledge to manage patients with complex conditions. As of January 2019, it is operating from more than 150 hubs in 45 states and addressing 100 complex conditions — in addition to an increasing global footprint.

Despite receiving financial support from an array of federal, state, and local government grants and national foundations, Project ECHO has no ongoing federal funding stream. In this context, with support from the Robert Wood Johnson Foundation, The Leona M. and Harry B. Helmsley Charitable Trust, and the GE Foundation, the Center for Health Care Strategies (CHCS) sought to explore the range of federal policy levers and funding streams that could support Project ECHO’s long-term sustainability.

This report presents a set of state and federal level policy options for how ECHO could be paid for through federal and state funding mechanisms. The recommendations are based on feedback from a group of experts convened by CHCS who have deep knowledge of Medicaid, Medicare, graduate medical education, and federally qualified health centers. Each option includes: (1) a brief discussion of how it would work; (2) its rationale and potential impact; (3) the action steps required for implementation; and (4) CHCS’ assessment of its feasibility.