Delivery of Care

Expanding the learning curve

Healthcentric Advisors launches its first Project ECHO program, focused on reducing opioid use through pain-management education for physicians

Photo by Richard Asinof

Members of the Healthcentric Advisors Project ECHO team. From right, Stephanie Baker, program manager and facilitator; Cindy Stephanopoulus, clinic education coordinator and facilitator; and Ann Marie Day, clinic education coordinator and facilitator.

By Richard Asinof
Posted 4/1/19
The adoption of the Project ECHO model for telementoring, provider to provider, by Healthcentric Advisors, has made a promising start in three states, focusing on reducing opioid use through pain management education.
What are the opportunities to expand the use of Project ECHO as a way to build a network of provider-to-provider mentoring in Rhode Island and the region? Will the Anchor Recovery Community Center consider adopting Project ECHO as part of their toolbox in supporting the work of peer recovery specialists? What kinds of financial incentives can be provided by health insurers and health systems to expand the use of Project ECHO? Could the technology and system be employed as a patient-to-patient mentoring system?
A new provider, Oak Street Health, for Medicare members insured through Blue Cross & Blue Shield of Rhode Island, will soon begin offering services at three locations, including one in Warwick and two in Providence, according to The Rhode Ahead, a publication of the health insurer, announcing that there will soon be “new doctors in town.”
The services will be provided in collaboration with Blue Cross & Blue Shield of Rhode Island, and will feature same-day or next-day appointments, transportation to and from Oak Street Health appointments, and 24/7 telephone support.
According to the story, Oak Street Health centers across the country have reduced emergency room visits and hospital admissions by more than 40 percent.
The collaboration around providing clinical services for Medicare members points to the increasing demographic for Medicare enrollment as Baby Boomers age as well as desire by health insurers to develop innovative approaches to control medical costs.

PROVIDENCE – Most telemedicine models are based on expanding access of patients to clinical caregivers, as a way of dispensing cost-effective care in a timely fashion to patients, overcoming barriers such as distance and the scarcity of providers.

However, the new program launched by Healthcentric Advisors, the Quality Improvement Organization for Medicare in New England, offers a different kind of model – a “telementoring” platform, designed to help physicians to support treatment of complex medical conditions by being able to consult with each other, on a regular basis, using the Project ECHO model.

No, Project ECHO model is not related in any way, shape or form to Amazon’s voice-activated Echo platform.

ECHO stands for Extension for Community Healthcare Outcomes; it was originally developed in New Mexico in the early 2000s by a physician as a way of sharing information between providers on the treatment of Hepatitis B.

The underlying organizing concept is to create what is known as “hub-and-spoke knowledge-sharing networks,” which are led by expert teams, who use multi-point videoconferencing to conduct virtual clinics with community providers.

As Susan Rowher, senior communications coordinator at Healthcentric Advisors described the difference between telemedicine and telementoring, “With telemedicine, you basically bring the patient to a technology or the technology to a patient, to enable physicians to interact with that patient,” she explained.

This model is different, Rowher continued. “We’re not interacting with other people’s patients; what we are doing is enabling providers to share their particular clinical expertise with other clinicians.”

Project ECHO now operates in 30 states nationally, covering 45 different complex conditions; globally, in has 86 hubs in more than 13 countries. The model has been expanded beyond health care to include education, law enforcement and peer mentoring

ConvergenceRI recently met with the project team managing the first Project ECHO program coordinated by Healthcentric Advisors, including videoconferencing with two participating providers, to learn more about the organization’s initial project: reducing opioid use through pain-management education, or ROPE, focused on the care of older adults.

Among the topics being addressed are non-pharmacological approaches to treating pain, including screening, trauma-informed care, stigma and language, according to a recent blog post by Healthcentric Advisors.

Dr. Julio Defillo-Draiby, an assistant professor of Medicine at the Alpert Medical of Brown University who serves as a Geriatric Inpatient Clinical Consultant for Care New England, working out of Kent Hospital, described some of the content of conversations that have occurred in the first three sessions.

“One of the things we want to reach out about is how some drugs may be inappropriate for older adults,” he said. Also, how to properly assess the aches and pains in older adults, he added. The sessions help physicians to be able to see the patient from a more holistic point of view.

In terms of some of the things that he has seen in big hospitals, Defillo-Draiby continued, “There are patients coming in with side effects of inappropriate drugs, or aches and pains that are not well-managed,” conditions that the Project ECHO sessions seek to address.

Another member of the Healthcentric Advisors Project ECHO provider team is Caitlin Kennedy, PharmD; a clinical pharmacist and the managed care coordinator for Coastal Medical, a primary care-driven Accountable Care Organization.

Kennedy said that participants in the Project ECHO initiative had been recruited “across the care continuum,” including community physicians, people focused on nursing home care, and hospital-based providers. “The folks that practice exclusively in hospitals may not know about the services that are available at community health centers,” she explained, saying that the telementoring sessions are a good opportunity to share information across the various settings.

Future plans
For the moment, the initial Project ECHO program is seen as a work in progress, with seven sessions scheduled and three completed, connecting providers through the organization’s offices in Brunswick, Maine, Woburn, Mass., and Providence. Eventually, the plans are to expand Project ECHO to all of the New England states.

In terms of metrics, the measurement of outcomes will be focused on the physicians’ knowledge gain, and the satisfaction and confidence gained in their ability to treat their patients.

In rolling out the program, the Healthcentric Advisors said that they had not encountered resistance from the participating providers. Rather, there had been what was described as some initial apprehension. “Especially in the beginning,” Stephanie Baker, program manager and facilitator for the Project ECHO program. “Getting providers to present cases, because they are meeting with people who are not someone with whom they have worked before, it may not be comfortable to come out and say: ‘I’m stuck.’”

That apprehension, Baker continued, has lessened with each session.


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