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2.5.20

A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care

J Gen Intern Med. 2020 Jan;35(1):21-27. doi: 10.1007/s11606-019-05206-0. Epub 2019 Oct 30. [Pubmed Abstract]

Komaromy M, Bartlett J, Gonzales-van Horn SR, Zurawski A, Kalishman SG, Zhu Y, Davis HT, Ceballos V, Sun X, Jurado M, Page K, Hamblin A, Arora S

Background
A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.

Objective
To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases.

Design
Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care.

Participants
ECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder.

Intervention
ECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients’ physical, behavioral, and social issues.

Main Measures
We assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions.

Key Results
ECHO Care was associated with significant changes in patients’ use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care.

Conclusions
ECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions.

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