Project ECHO takes on challenge of 'superusers'

Project ECHO (Extension for Community Healthcare Outcomes) has taken on a new challenge: to help primary care teams improve care and lower costs of so-called 'superuser' patients, according to a blog post on NEJM Catalyst.

Project ECHO, a rural telemedicine project launched by the University of New Mexico Health Sciences Center in 2003, is now focusing on superuser patients, many of whom have serious mental health or addiction problems in addition to physical health issues.

The ECHO team is now using the program to help doctors in New Mexico manage complex patients, according to the article. Researchers are using an $8.4 million grant from the Centers for Medicare & Medicaid Innovation to focus on Medicaid patients who account for a disproportionate share of spending.

In working with these Medicaid beneficiaries, the ECHO team found that 90 percent of the patients also deal with behavioral health problems--often substance abuse and personality disorders--that are further complicated by poverty and homelessness. Miriam Komaromy, M.D., associate director of Project ECHO, told NEJM Catalyst that mental health issues are "the elephant in the room" when it comes to patients with complex medical problems.

Project ECHO works by linking university-based faculty specialists to primary care providers in rural and under-served areas using videoconferencing to help train them. It is the first time Project ECHO has focused on training teams of providers rather than individual clinicians. The teams are staffed and funded by Medicaid managed care plans and are made up of a lead clinician, who is either a physician assistant or nurse practitioner, a nurse, a social worker and two community health workers. Part of their work is to link patients with support services, the article noted.

After a year of operation, Project ECHO found that 80 percent of people said they got the help they need, and hospitalizations dropped by 27 percent and emergency department visits by 32 percent.

To learn more
- read the NEJM Catalyst article
- visit the Project ECHO web site