Project ECHO: Supporting Primary Care Providers to Address Complex Conditions

Better Health Conference 2019June 6, 2019

Lise TancredeProject Manager, Qualidigm

Marlene MoraninoSenior Director of Clinical ProgramsCommunity Health Center Association of Connecticut

Presenters

Today’s Objectives

• Understand Project ECHO® fundamentals• Raise awareness of the Benefits and Value of

Project ECHO• Gain familiarity with the regional ECHO

programs offered by CHCACT, Qualidigm and the Northern New England ECHO Network

What is Project ECHO?

Project ECHO® is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases

workforce capacity to provide best practice specialty care and reduce health disparities through its hub-and-spoke knowledge sharing networks

People need access to specialty care for complex conditions

Not enough specialists to treat everyone,

ECHO® trains primary care clinicians to

provide specialty care services

Patients get the right care, in the right place,

at the right time.

Copyright © ECHO Institute

Extension of Community Healthcare Outcomes

Project ECHO Mission

Project ECHO (Extension for Community Healthcare Outcomes) is a:

▪ movement to demonopolize knowledge and amplify local capacity to provide best practice care for underserved people all over the world.

▪ The ECHO model™ is committed to addressing the needs of the most vulnerable populations by equipping communities with the right knowledge, at the right place, at the right time.

▪ Goal is to touch the lives of 1 Billion people by 2025.

The ECHO Model

Amplification – Use Technologyto leverage scarce resources

Share Best Practices to reduce disparity

Case Based Learningto master complexity

Web-based Database to Monitor Outcomes

Copyright © ECHO Institute

HUB AND SPOKE MODEL

Graphic and visual conceptual framework used with permission from Kent Unruh and Project ECHO.

ECHO model is not ‘traditional telemedicine’. Treating Physician retains responsibility for managing patient.

ECHO Creates VALUE for All Parts of the Healthcare System

• Patients• The Community• The Community Clinic• The Engaged Provider (spoke)• The Center of Excellence (hub)• The System (payers)

Copyright 2017 Project ECHO®

Hubs in New England Community Health Center Association of CT Hub Hartford Health and Human Service Hub Weitzman Institute Hub

Connecticut

Massachusetts

UMass Memorial Medical Group Lurie Center for Autism Boston Medical Center Beacon Health Options

Vermont

University of Vermont (UVM)

New Hampshire

Dartmouth Hitchcock University of New Hampshire (UNH)

Maine MaineHealth Maine Medical Center Quality Counts, a Qualidigm Company MCD Public Health

Northern New England Network (NNE Network)

Community Health Center

Association of CT

CHRONIC PAIN AND ADDICTIONS

Project ECHO

Choosing the Topic: Chronic Pain and Addictions

Community Health Center Association of CT –Primary Care Association

Mission is to advance and align the work of health centers with stakeholders to improve the health and wellness of all.

Pain management in the context of the Opioid epidemic

The Goals

▪ Increase access to evidence-based practices for diagnosis and treatment of SUDs and chronic pain.

▪ Join a community of practice to build capacity and competency for diagnosis and treatment of SUDs and chronic pain.

▪ Present de-identified individual patient cases related to the diagnosis, treatment or prevention of SUDs and chronic pain with content experts and peers.

Our ECHO Experience▪ The “Spokes” or teams from 5 Health centers

▪ The “Hub” /subject matter Experts- included specialists in Addiction Psychiatry, Chronic Pain Management/non-opioid alternatives and Pharmacy.

▪ Determine the frequency and time- 90 minute sessions

▪ Each session begins with (15 to 20 minute) didactic presentation developed by the specialist panel on specific topics of interest.

▪ Followed by providers presenting deidentified patient cases All participants are encouraged to contribute actively to case discussions.

CASE BASED LEARNING▪ HIPPA complaint, in-depth case-based presentations by

clinicians for feedback and recommendations

▪ Case can be a patient they are struggling with or had success with using some innovation

▪ The SMEs provide feedback and recommendations to the clinician, and the peers join in the discussion to provide any feedback or questions.

▪ This type of case-based learning enhances their ability to extend specialty care to the patients. Limits some of the patient barriers to some treatments

Example of Case

POWERFUL LEARNING TOOL: A mix of work and learning

▪ A group learning, best practices, guidelines and protocols reduce variation in care and improve outcomes for patients

experiencing chronic pain and SUDaccess to evidence-based educational resources, treatment guidelines,

tools, and patient resources▪ Benefit from the collective expertise of multi-disciplinary specialists experts trained in addiction psychiatry and chronic pain management experiences of other practitioners who provide direct patient care. ▪ Join a supportive network of peers▪ Build confidence in caring for complex patients and enable some treatment to be provided at the health center level.▪ FREE CMEs

Lessons Learned

Commitment of Time▪Clinician time- Leadership buy in▪CMEs management ▪Program development and facilitation▪Case submission

FUNDING▪Grant writing and reporting

Technology- Zoom

Meeting the needs of the “Spokes”▪Added a medical research librarian▪Added a MD with medical toxicology training and FQHC experience▪Added non FQHCs clinicians

Chronic Pain and Addictions Statistics

Total sessions - 18 ▪27 hours ▪18 didactics delivered▪1 at every session

Participants▪ 281 total participants▪ Average 15 per session

Breakdown by specialty▪10 physicians/MDs▪12 Advanced Practice▪5 Registered Nurses▪1 medical assistant▪5 mental health professional , LCSW, LPCC etc.▪Other 19- pharmacy students, other non clinical - from academic programs, project ECHO staff etc.

Evaluation Data

Scale of 1 -5▪1 being not effective at all▪5 being highly effectiveInformation from this activity will be incorporated into my medical practice:

4-5 highly effective

Provided practical suggestions I can apply in my practice:

4 -5 highly effective

92 %

78 %

% Patients dispensed an opioid with a toxicology screen

21.00%

27.00%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

1

% O

F M

EMBE

RS

AGGREGATE DATA ROLLING 5 MONTHS AVERAGE

non-ECHO participants ECHO Participants

Based on Medicaid claims for Health Center Members

Patients filling Opioid Prescription above 100 MME

10.50%

7.25%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

1

% O

F M

EMBE

RS

AGGREGATE DATA ROLLING AVERAGE 5 MONTHS

non-ECHO participants ECHO Participants

Based on Medicaid claims for Health Center Members

Evaluation Comments

Changes in my practice I am going to make:▪Discuss attainable pain goals with patients.▪Screening and evaluate appropriate pain regimen▪Be cautious with patients with comorbid substance abuse▪Refer to NA, Al Anon, Narcanon▪Close attention to "diversion" potential must be paid ▪Consistent urine testing ▪Re-evaluate while patients are in pre-contemplation▪More motivational interviewing ▪Info on benzos with buprenorphine was helpful▪Gave real life situations to be careful of(ie pt. selling meds)▪Offer more info about alternative practices

Evaluation Comments

Barriers to change▪Getting patients in support programs

▪Staff support for patient follow-up

▪I am a lead clinician in our Suboxone program, already implementing much of this info, however it was great re-fresh and covered info I often like to share with colleagues

▪New APRN, still learning barriers and practice standards

▪The suggestions in the presentation are inherent to my practice as a clinician and implemented regularly already

ECHO Programming from the Project ECHO NNE Network & Qualidigm

Network Mission▪ The mission of the Project ECHO NNE Network is to design and

implement a regional network of telehealth services using the Project ECHO model to improve access, care delivery, outcomes and health for Northern New Englanders residing in Maine, New Hampshire and Vermont. The Project ECHO NNE Network will support providers and patients to work effectively together to manage common, emerging and complex conditions safely, effectively and compassionately.

Network Shared Vision ▪ The overarching vision for the Project ECHO NNE Network is to

enhance access and improve health outcomes throughout the Northern New England region.

Project ECHO: Northern New England Network

NNE Network & Qualidigm Program Details• Project ECHO: Capacity Building for Compassionate Tapering

o 11 sessions (10/2017- 5/2018)• Project ECHO: Clinical Peer Leadership

o 28 sessions (12/2017 -present)• Project ECHO: Continuity of Care for Substance Use and

Exposure During the Perinatal Period (Perinatal SUD)o 11 sessions (1/2017-9/2018)

• Project ECHO: Community Opioid Overdose Response (COOR)o 14 sessions (8/2018-present)

• Project ECHO: Medication Assisted Treatment (MAT)o 11 sessions (8/2018-present)

• Project ECHO: Older Adult Careo 9 sessions (10/2018-present)

NNE Network & Qualidigm Program Participation

Across all QC and NNE Network ECHO programs, a total of 84 ECHO sessions (including orientations and Mock ECHOs) were delivered between 9/1/17-4/30/19.

o Individual attendees who participated: 434o Total attendance across all ECHO programs:

1500+ o Participant locations: Maine, New Hampshire

and Vermont

Project ECHO: Perinatal Substance Use Disorders

Results Summary Continued

Steps for Implementation Timeline▪ Establishing an ECHO Hub - partnership with the ECHO

Institute™, attending Immersion Training, an onboarding Hub Technical Team (recommended 2-3 Months)

▪ ECHO Program Planning, Development, Recruitment and Training of Faculty & Participants (typically 2-3 Months)

▪ ECHO Session Program Delivery (typically 1 or 2 sessions per month)

▪ Evaluation/Reporting (1 Month)

Program Budget ConsiderationsPersonnel for Running ECHO Sessions• IT User Support • Coordinator/Administrator • Medical Director

HUB Expert Clinical Team (4-5)

Replication Training at ECHO Institute, UNM (Albuquerque, NM) • Average per person ($1,500)

Technical Requirements • High speed internet (hard-wired recommended)• Videoconferencing software (Zoom)• ECHO Clinic Management Software (iECHO™)

Teleconferencing equipment• Dedicated room computer • Dual monitors - recommended• Speakerphone & webcam – recommended Logitech GROUP videoconferencing kit

Evaluation • Using iECHO/ other ECHO Institute tools• Survey Monkey or other on-line survey tools

ECHO Hub Studio Setup

Other ECHO Programs in Development

NNE Network and Qualidigm • MAT in the ED• HPV QI• Lung Cancer Screening• MAT Readiness

CHCACT• Community Health Workers (CHW)• Support Practice transformation and value based payment models• Expansion of the Transforming Clinical Practice Initiatives

Questions?

Contact Information

Lise Tancrede, Project Manager, Quality Counts, a Qualidigm Companyltancrede@mainequalitycounts.org 207 620-8526 X1001If you would like to learn more about our ECHO programs please visit: https://mainequalitycounts.org/initiatives-resources/echo-test/If you would like to join our mailing list for upcoming opportunities please email Jonathan Church at jchurch@mainequalitycounts.org

Marlene Moranino, Senior Director of Clinical Programs, Community Health Center Association of CT MMoranino@chcact.org 860-667-7820 Website - www.CHCACT.orgIf you would like to learn more about our ECHO programs please visit:https://www.chcact.org/about/projectecho/Join us on social media: @cthealthcenters www.facebook.com/CHCACT If you would like to join our mailing list for upcoming opportunities please email:Deb Polun at DPolun@chcact.org