CONTEXT | Emergency utilization and the associated costs are rising, driven in large part by patients with complex social and medical needs who commonly access their healthcare through the emergency department (ED) rather than outpatient settings. The Extension for Community Health Outcomes (ECHO) is a model that uses video conferencing to link specialist and outpatient providers for case-based mentoring. By crowdsourcing expertise through ECHO, outpatient providers can deliver specialized care to address their complex patients' needs outside of the hospital. While previous research has established the feasibility of implementing ECHO Care to address high-need Medicaid patients, less is known about the impact on cost of care for this group.
STUDY OBJECTIVE | Determine whether ECHO helps reduce utilization of inpatient and emergency care among high-need, high-cost Medicaid patients.
THE DETAILS | 770 Medicaid-insured patients in New Mexico received intensive outpatient care by interdisciplinary outpatient teams made up of nurse practitioners or physician assistants and behavioral health providers, community health workers, and nurses. Nearly all patients had a chronic mental illness, and more than three-quarters had a chronic substance use disorder. The care teams were supported through weekly ECHO sessions with 16 multidisciplinary specialists, including in psychiatry, gastroenterology, addiction, endocrinology, and pharmacy. Using Medicaid claims, researchers looked at healthcare utilization and expenditures before and after ECHO implementation.
FINDINGS | Twelve months after enrolling in ECHO, the patients' odds of experiencing an ED visit or inpatient admission were nearly 50% lower compared to pre-enrollment trends, likely attributable to their higher odds of having an outpatient visit (23%) or dispensed prescription (8%). Implementing this care model did not increase costs, and over time has the potential for financial savings.
PULL QUOTE | "This modified use of healthcare resources is indicative of greater access to effective care, and improved communication and trust with patients' care teams."
SO WHAT? | Complex medical and social needs such as transportation insecurity and psychiatric disorders can pose a problem for keeping appointments with multiple specialists. Applying the ECHO model to complex care management in an outpatient setting can help decrease care fragmentation and improve outcomes while also managing costs associated with inpatient and ED utilization.
Source. Komaromy et al. (2019). A Novel Intervention for High-Need, High-Cost Medicaid Patients: A Study of ECHO Care. Journal of General Internal Medicine.