!"!"#$%

#%

How Telehealth is Changing Delivery of Care for Complex

Patients &'()*+%,-)+./012%342%5642%789%

4-)/*%5+'+:*)2%97;<%7+)*%

=45%>)?@*AB%97;<%

Project ECHO (Extension for Community Health Outcomes)

!"!"#$%

C%

DE*%F1//1?'%?G%>)?@*AB%97;<%1/%B?%(*H*I?J%BE*%

A+J+A1BK%B?%/+G*IK%+'(%*L*AMH*IK%B)*+B%

AE)?'1A2%A?FF?'%+'(%A?FJI*N%(1/*+/*/%1'%

)-)+I%+'(%-'(*)/*)H*(%+)*+/%+'(%B?%F?'1B?)%

?-BA?F*/O!

>)?@*AB%97;<%P1(*?%

ECHO Foundations Q%-/*%?G%H1(*?A?'G*)*'A1':%

Q%A+/*RS+/*(%I*+)'1':%%

Q%(1/*+/*%F+'+:*F*'B2%G?A-/*(%?'%*H1(*'A*RS+/*(%A+)*%J)?B?A?I/%%

Q%-/*%?G%.*SRS+/*(%(1/*+/*%F+'+:*F*'B%B??I/%B?%B)+A0%?-BA?F*/%

• %/-JJ?)B%G?)%+%B*+FRS+/*(%+JJ)?+AE%B?%AE)?'1A%(1/*+/*%F+'+:*F*'B%

!"!"#$%

T%

• U-+I1BK%+'(%/+G*BK%• 3+J1(%I*+)'1':%+'(%S*/BRJ)+AMA*%(1//*F1'+M?'%

• 3*(-A*%H+)1+M?'/%1'%A+)*%• &AA*//%G?)%)-)+I%+'(%-'(*)/*)H*(%J+M*'B/2%)*(-A*(%(1/J+)1M*/%• V?)0G?)A*%B)+1'1':%+'(%G?)A*%F-IMJI1*)%

• 8*F?'?J?I1W*%0'?.I*(:*%

•  XFJ)?H1':%J)?G*//1?'+I%/+M/G+AM?'%+'(%)*B*'M?'%%

•  6-JJ?)M':%BE*%5*(1A+I%;?F*%5?(*I%

• 7?/B%*L*AMH*%A+)*R%+H?1(%*NA*//1H*%B*/M':%+'(%B)+H*I%• >)*H*'B%A?/B%?G%-'B)*+B*(%(1/*+/*%Y*O:OZ%I1H*)%B)+'/JI+'B%?)%(1+IK/1/[%

"#$%&'()!*%&%+$,!#-!ECHO Model $#!.%()$/!01,$%2

!"!"#$%

$%

!"!"#$%

\%

ECHO Replication in US: •  3&45%6,4$1!#-!7(,/4&8$#&!Y;7P2%7E)?'1A%>+1'2%;XP2%&((1AM?'[%•  3&45%6,4$1!#-!9/4:(8#!Y;KJ*)B*'/1?'2%])*+/B%7+'A*)2%&8;82%7E1I(E??(%<S*/1BK[%•  ;%<(6$2%&$!#-!;%-%&,%!^%V?)I(.1(*%X'1M+MH*%Y7E)?'1A%>+1'[%

•  =%$%6(&>,!?@24&4,$6('#&!.%()$/!01,$%2%R%##%3*:1?'/%Y7E)?'1A%>+1'2%81+S*B*/2%;*+)B%_+1I-)*2%;7P2%V?F*' /̀%;*+IBE2%4*JE)?I?:K[%

•  3&45%6,4$1!#-!A%5(@(!Y81+S*B*/"7+)(1?H+/A-I+)%31/0%3*(-AM?'2%6J?)B/%5*(1A1'*2%DEK)?1(%a%81+S*B*/2%&'MS1?MA%6B*.+)(/E1J2%5*'B+I%;*+IBE[%%

•  3&45%6,4$1!#-!A%5(@(B!C%&#!Y3E*-F+B?I?:K[%

•  3&45%6,4$1!#-!3$(/!Y;7P2%&(H+'A*(%b1H*)%7+)*[%•  3&45%6,4$1!#-!0#D$/!E)#64@(F!GH?9!(&@!E)#64@(I9(64JJ%(&F!?GH9!Yc*'*)+I%;XP2%&(?I*/A*'B/">*(1+B)1A/%;XP2%;7P";XP%7?RX'G*AM?'2%>/KAE1+B)K%a%

;XP2%6J+'1/E%b+':-+:*%;XP[%

•  .(65(6@F!*%$/!K,6(%)!;%(:#&%,,!L%@4:()!9%&$%6!Y;7P2%c*)?'B?I?:K%^%97;<%&c9[%•  0$!M#,%</!.#,<4$()!(&@!L%@4:()!9%&$%6!^%&)1W?'+%Y;7P[%•  9#22D&4$1!.%()$/!9%&$%6F!K&:N!^%7?''*AMA-B%Y;XP2%;7P2%7E)?'1A%>+1'2%<J1?1(%&((1AM?'%^%]-J)*'?)JE1'*[%•  O?!A%$F!"6#P%:$!G9.Q!O?!Y&&>&%>)*H*'MH*%7+)*2%4*JE)?I?:K2%&(-IB%>/KAE1+B)K[%•  0$N!ODR%>,!.%()$/!*(1)#6!0$N!ODR%>,!L%@4:()!9%&$%6!^%D*N+/%Y;7P[%•  3ALB!G&54,4#&!AL%Y7E1I(E??(%<H*).*1:EB%5*(1A+I%5+'+:*F*'B2%>*(1+B)1A%4-B)1M?'2%>/KAE1+B)K2%&/BEF+">-IF?'+)K[%

•  3ALB!9%&$%6!-#6!;%5%)#<2%&$!(&@!;4,(J4)4$1!Y&-M/F[%

•  3&45%6,4$1!#-!9()4-#6&4(!;(54,!Y>+1'%5+'+:*F*'B[%

•  3&45%6,4$1!#-!71#24&8!^%VK?F1':%X'/MB-B*%G?)%81/+S1I1M*/%Y&//1/MH*%D*AE'?I?:K[%

•  Q:/,&%6!.%()$/!01,$%2!^%4*.%<)I*+'/2%b&%Yb1H*)%7+)*[%

!"!"#$%

d%

ECHO Replication Sites Worldwide:

• L(D)(&(!?S(@!L%@4:()!9#))%8%%^%4*.%8*IE12%X'(1+%Y;XP[%

•  K&,'$D$%!#-!O45%6!(&@!*4)4(61!0:4%&:%,!^%4*.%8*IE12%X'(1+%Y;7P[%•  K&@4(!^%5-FS+12%7E+'(1:+):E2%a%b-A0'?.%Y&-M/F[%

•  36D8D(1%Yb1H*)%81/*+/*[%• 7%,$IA#6$/!7%,$!.#,<4$(),!T6#D<!^%c+I.+K2%X)*I+'(%Y3E*-F+B?I?:K2%9'(?A)1'?I?:K[%

•  9(&(@(!U!3&45%6,4$1!#-!H#6#&$#!^%<'B+)1?%Y7E)?'1A%>+1'[%

ECHO Care: a program to care for complex Medicaid

patients

!"!"#$%

!%

ECHO Care is a special health care program designed to support

Medicaid patients who have complex health care needs

Mr. L is a 54 year old man who has diabetes and high blood pressure. DE*%(1+S*B*/%E+/%A+-/*(%*K*%(+F+:*%BE+B%

E+/%F+(*%E1F%+IF?/B%SI1'(2%+'(%J)?SI*F/%

.1BE%E1/%G**B%BE+B%I*+(%B?%+FJ-B+M?'%?G%E1/%

)1:EB%G??BO%;*%1/%?'%(1/+S1I1BKO%

;*%1/%(*J)*//*(%+'(%1/?I+B*(2%+'(%E+/%B)?-SI*%

:*e':%B?%F*(1A+I%+JJ?1'BF*'B/O%

;*%E+/%S**'%E?/J1B+I1W*(%BE)**%MF*/%BE1/%

J+/B%K*+)%.1BE%J'*-F?'1+2%+%G??B%1'G*AM?'2%

+'(%(*J)*//1?'O%

!"!"#$%

f%

Our existing systems of care are not designed for patients like Mr L

VE+B%01'(%?G%S+))1*)/%.?-I(%5)O%b%G+A*%1G%E*%

/?-:EB%A+)*%1'%+%B)+(1M?'+I%J)1F+)K%A+)*%

/*e':g%

Current system fails complex patients

_+1I/%B?Z%

•  &(()*//%/?A1+I%S+))1*)/%•  >)?H1(*%1'B*'/1H*%?-BJ+M*'B%A+)*%•  >)?H1(*%A??)(1'+B*(%A+)*%•  X'B*:)+B*%JEK/1A+I%+'(%F*'B+I%E*+IBE%A+)*%

•  >)*H*'B%E?/J1B+I1W+M?'%•  7?'B+1'%A?/B/%

!"!"#$%

h%

The most complex and costly patients • 5-IMJI*%A?FJI*N%1II'*//*/%

• 8?-SIK%?)%iB)1JIKj%(1+:'?/*(kJEK/1A+I2%F*'B+I2%

+'(%+((1AM?'%(1+:'?/*/%

• 6*H*)*%/?A1+I%S+))1*)/%B?%E*+IBE%• b1F1B*(%/?A1+I%/-JJ?)B%%

5% of medicaid patients account for almost 60% of medicaid

dollars

&I1lI*)*+I1BKOSI?:/J?BOA?F%

5% of medicaid patients account for almost 60% of medicaid dollars

!"!"#$%

#m%

Why is the care of these patients so expensive?

• 9'?)F?-/%S-)(*'%?G%(1/*+/*Z%JEK/1A+I%+'(%F*'B+I%

• !Cn%?G%J+M*'B/%E+H*%+((1AM?'%(1+:'?/*/%• fCn%E+H*%F*'B+I%1II'*//%(1+:'?/1/%

• &H*)+:*%?G%T%AE)?'1A%1II'*//%A?'(1M?'/%%• ;?/J1B+I1W+M?'%1/%G)*o-*'B%• ;+IG%?G%E?/J1B+I1W+M?'/%+)*%BE?-:EB%B?%S*%!"#$%!&'()• 3*(-A1':%E?/J1B+I1W+M?'/%SK%E+IG%.?-I(%/+H*%F1II1?'/%

?G%(?II+)/%J*)%K*+)%

Goals of ECHO Care

XFJ)?H*%

o-+I1BK%?G%

A+)*%

8*A)*+/*%

A?/B%?G%

A+)*%

!"!"#$%

##%

Outpatient “Intensivist” Team (OIT) becomes the patients’ PCP

ElJZ""+)B+/BJ)?(-AM?'/O.?)(J)*//OA?F"Cm##"mT"#\"f\"%

How does ECHO Care support complex needs?

•  XFJ)?H*/%J)1F+)K%A+)*%

R%D*+FRS+/*(2%F-IM(1/A1JI1'+)K%

R%7??)(1'+B*(2%E1:ER1'B*'/1BK%A+)*%

R%X'B*:)+B*(%JEK/1A+I%+'(%F*'B+I%E*+IBE%A+)*%

R%&(()*//*/%/?A1+I%S+))1*)/%

R%_?A-/%?'%iB)+'/1M?'/j%?G%A+)*%

R%4?B%S1II*(%+/%G**RG?)%/*)H1A*%A+)*%

•  XFJ)?H*/%+AA*//%B?%A??)(1'+B*(%/J*A1+IBK%A+)*%

– 97;<%7?FJI*N%7+)*%7I1'1A%Y777[%

!"!"#$%

#C%

Multidisciplinary, Integrated

4>%

7;V%

7;V%34%

7?-'

/*I?)%

5)O%b%

97;<%7?FJI*N%7+)*%6J*A1+I1/B/%

ECHO Complex Care Clinic

!"#$%&'()*++',,)-%)+%%$(./*-'(),#'+.*0-1)+*$')

!"!"#$%

#T%

Where are the ECHO Care teams? • &IS-o-*)o-*%F*B)?%+)*+%

• =45%6?-BE*+/B%;*1:EB/%7I1'1A%

• =45%6?-BE.*/B%5*/+%7I1'1A%

• _1)/B%7E?1A*%7?FF-'1BK%;*+IBEA+)*%Y6O%P+II*K[%

• b+/%P*:+/2%45%

• 9I%7*'B)?%_+F1IK%;*+IBE%

• b+/%7)-A*/%• 5*F?)1+I%5*(1A+I%7*'B*)%%

• 6+'B+%_*%• b+%_+F1I1+%5*(1A+I%7*'B*)%

Patients to refer to ECHO Care: • 5*(1A+1(%F+'+:*(%A+)*%

• D.?%?)%F?)*%J??)IK%A?'B)?II*(%F*(1A+I"%

S*E+H1?)+I%A?F?)S1(1M*/%

&48%

• T%?)%F?)*%98%H1/1B/%.1BE1'%BE*%J+/B%d%F?'BE/%

<3%

• C%?)%F?)*%E?/J1B+I%+(F1//1?'/%1'%BE*%J+/B%K*+)2%

.1BE%?'*%E+H1':%S**'%.1BE1'%BE*%J+/B%d%F?'BE/%

!"!"#$%

#$%

Patients who are not eligible for ECHO Care:

• p?-':*)%BE+'%#f%K*+)/%?I(%• 8-+I%*I1:1SI*%Y'?B%+I1:'*([2%5*(1A+)*2%?)%J)1H+B*%

1'/-)+'A*%

• 3*/1(1':%1'%BE*%I?':RB*)F%A+)*%G+A1I1BK%

• 9')?II*(%1'%E?/J1A*2%&7D%?)%>&79%J)?:)+F/%

• 5?H1':%?-B%?G%97;<%7+)*%+)*+%.1BE1'%#f%F?'BE/%

3*G*))+I%G?)F/%+H+1I+SI*%+BZ%

ElJZ""*AE?O-'FO*(-"*AE?A+)*?J*)+M?'/"*R

F+:"1'(*NOEBFI%

!"!"#$%

#\%

ECHO Endocrinology

Endocrinology Centers of Excellence

• 6**01':%B?%*/B+SI1/E%f%7<9/%BE)?-:E?-B%45%

• 7<9/%.1II%/*)H*%+/%)*G*))+I%A*'B*)/%G?)%9'(?A)1'*%J+M*'B/%1'%BE*1)%/*)H1A*%+)*+/%

• 7<9/%+)*%JI+''*(%1'%BE*%G?II?.1':%+)*+/Z%

!"!"#$%

#d%

EN

DO

EC

HO

CO

E

Loca

tions

q%9'(?A)1'?I?:1/B%

q%>)?J?/*(%7<9%

Endo ECHO Primary Care Clinicians: •  X'1M+I%F1'1R)*/1(*'AK%1'%&]U%

•  9/B+SI1/E%?'*RB.?%.**0IK%9'(?A)1'*%)*G*))+I%AI1'1A/%%• V?)0%+/%+%B*+F%.1BE%7;V%

• &l*'(%.**0IK%9'(?%B*I*97;<%7I1'1A/%%•  DE*%/J*A1+I1/B%J+'*I%.1II%J)?H1(*%)*A?FF*'(+M?'/%

+'(%S*%+H+1I+SI*%G?)%G-)BE*)%A?'/-IB+M?'%

!"!"#$%

#!%

Endo ECHO CHWs • 3*o-1)*(%B?%+l*'(%+%>)?@*AB%97;<%739V%B)+1'1':%%

• _?A-/%#mmn%?G%BE*1)%MF*%?'%

(1+S*MA%J+M*'B/%

• >+)MA1J+B*%1'%BE*%.**0IK%9'(?%B*I*97;<%AI1'1A/%%

• &AA*//%B?%97;<%7;V/%G?)%

A?'/-IB+M?'%

Evaluation

• &%B*+F%G)?F%4*.%p?)0%='1H*)/1BK%Y4p=[%.1II%

A?'(-AB%BE*%*H+I-+M?'%

• 9H+I-+B*Z%• 7*'B*)%?G%9NA*II*'A*%B*+F /̀%0'?.I*(:*2%

A?'r(*'A*2%+'(%/+M/G+AM?'%

• >+M*'B%-MI1W+M?'2%*NJ*'(1B-)*/2%+(E*)*'A*%• >+M*'B%?-BA?F*/%/-AE%+/%;S&#72%]>2%b8b%

• >+M*'B%J*)/J*AMH*%

!"!"#$%

#f%

• c*B%/*B%-J%.1BE%,??F%6?s.+)*%

• >*(1+B)1A%9'(?%b*AB-)*Z%7%@&%,@(1F!MD)1!VF!WXYZ!

• 7I1'1A%I+-'AEZ%7%@&%,@(1F!?D8D,$!Y[F!WXYZ!

• _?)%F?)*%1'G?)F+M?'2%JI*+/*%A?'B+AB%4+BE+'%D)?K*)%+B%

'(B)?K*)t/+I-(O-'FO*(-%