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![Page 1: Click to edit Master title style - Center for Health …Click to edit Master title style ECHO Care: a program to care for complex patients Miriam Komaromy, MD Associate Director, Project](https://reader033.vdocuments.site/reader033/viewer/2022050103/5f41c348069e9d529f4cf71d/html5/thumbnails/1.jpg)
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ECHO Care: a program to care for complex patients
Miriam Komaromy, MDAssociate Director, Project ECHO
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ECHO Care is a special health care program designed to support patients
insured by Medicaid managed care who have complex health care needs and
high costs of care
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Click to edit Master title styleGoals of ECHO Care
Improve quality of
care
Decrease cost of
care
Improve patient
satisfaction
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• Federal CMMI grant
• Project ECHO has ECHO Care partnerships with: – NM state Medicaid office (HSD)
– All of the NM Medicaid managed care organizations (MCOs)
– Numerous Community Health Centers (CHCs)
• MCOs jointly provided salaries for the ECHO Care teams
• CHCs provided the clinic locations
Collaboration
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• Multiple complex illnesses
• Doubly or “triply” diagnosed—physical, mental, and addiction diagnoses
• Severe social barriers to health
• Limited social support
The most complex and costly patients
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Click to edit Master title styleWhere are the ECHO Care patients?
ECHO Care teams are located in “hotspots”
• All NM Medicaid patients ranked by likelihood of hospitalization in next year
• Mapped location of highest risk patients
• Up to 1/3 homeless
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• Two or more poorly controlled chronic complex diseases
• One hospitalization in past 6 months and another in past 12 months
– OR
• 3 or more ED visits in past 6 months
Enrollment Criteria
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Click to edit Master title styleHow does ECHO Care address these problems?
• Improves primary care- Team-based, multidisciplinary primary care- Coordinated, high-intensity care- Integrated physical and mental health care- Addresses social barriers- Focus on “transitions” of care- Not billed as fee-for service care
• Improves access to coordinated specialty care
– ECHO Complex Care Clinic (CCC)
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Click to edit Master title styleMultidisciplinary, Integrated Teams
NP
CHW
CHWRN
Counselor
patient
Psychiatry
Infectious Disease Pharmacy
Clinical Social Work
AddictionECHO Complex Care Specialists
Etc.
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Improved access to coordinated specialty care
ECHO Complex Care Clinic
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Click to edit Master title styleECHO Complex Care Clinic
• Case-based learning
– Synchronized treatment recommendations from multidisciplinary specialists
– Medical, behavioral and social aspects of care
– Resource sharing among teams
– Identifying systems barriers
• ECHO specialists also available for phone consultation to our teams
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• Launched 6 ECHO Care teams starting 10/2013 and ending 6/2016
• Project ECHO provided intensive training and support
– In-person training including motivational interviewing, trauma-informed care, crisis intervention, home visiting
– Weekly teleconferences before Complex Care Clinic, divided into disease-specific blocks including addiction, psychiatric illness, diabetes, liver disease, etc.
– Weekly Complex Care Clinic for case presentation and discussion
Implementation
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Click to edit Master title styleECHO Care evaluation • Analysis of claims data
– Utilization
– Costs
– Quality measures
• ECHO Care Surveys – Patient Satisfaction Survey – comparison of baseline and every
6 months following enrollment
– Surveys of ECHO Care team members and clinic administration
• Qualitative evaluation– Interviews with ECHO Care patients, caregivers, MCO care
coordinators, and ECHO Care team members, and Complex Care Clinic specialists
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• Contractual and legal relationship with 4 Managed Care Organizations, NM State Medicaid, and clinics
• Recruiting team leads
• Cultural clashes within teams and staff turnover
• Locating and recruiting patients
• IT/data collection
• Disenrollments
Challenges
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• 770 patients recruited
• Excellent, integrated care as demonstrated by improved outcomes (to be published)
• Complex Care Clinic
• Many products for replication of this model
Strengths