As 2016 comes to a close, digital health continues to be a focal point on both the state and federal levels. On December 6, 2016, the US House of Representatives passed the Expanding Capacity for Health Outcomes Act (S. 2873) (the ECHO Act), which was unanimously passed by the US Senate on November 29, 2016. The ECHO Act seeks to expand the use of health care technology and programming to connect underserved communities and populations with critical health care services.
By way of background, the ECHO Act is a product of the University of New Mexico Health Sciences Center’s telehealth initiative named “Project ECHO,” a world-renowned program launched in 2011 to address access to Hepatitis C care. Project ECHO uses a “hub-and-spoke” model to connect health care specialists with rural providers and their patient populations using a telehealth platform (e.g., multi-point videoconferencing). Under the model, specialists at a “hub” hospital conduct virtual clinics and training for primary care providers at “spoke” sites, including many rural health systems. As a result, quality patient care is provided and managed locally—without the need for referrals or patient/physician travel. Since Project ECHO’s inception in 2011, the model has expanded—across diseases, specialties, urban and rural settings, and different types of payment models—and has been adopted by governmental agencies and in other countries.
The ECHO Act builds upon the University of New Mexico’s telehealth initiative by encouraging the broader development and use of technology-enabled collaborative learning and care delivery models by connecting specialists with multiple other health care professionals through simultaneous interactive videoconferencing for the purpose of facilitating case-based learning, disseminating best practices, and evaluating outcomes. A significant driver behind the ECHO Act is the need to address health professional shortages in rural areas and to provide support to rural providers who are struggling to meet patient demand. As background, only about 10 percent of physicians practice in rural areas of the United States—despite nearly one-fourth of the population living in these areas.
The ECHO Act requires the secretary of the US Department of Health and Human Services (HHS) to study technology-enabled collaborative learning and capacity building models, and the impact of those models on (1) certain health conditions (i.e., mental health and substance use disorders, chronic diseases, prenatal and maternal health, pediatric care, pain management, and palliative care); (2) health care workforce issues (e.g., specialty care shortages); and (3) public health programs. Within two years of the enactment of the ECHO Act, the secretary of HHS must submit a publically available report to Congress that:
- Analyzes the impact of technology-enabled collaborative learning and capacity building models, including, but not limited to, the impact on health care provider retention, quality of care, access to care and barriers faced by health care providers
- Lists the technology-enabled collaborative learning and capacity building models funded by HHS over the past five years
- Describes best practices used in adopting these models
- Describes barriers to adoption of these models, and recommends ways to reduce those barriers and opportunities to increase use of these models
- Issues recommendations regarding the role of technology-enabled collaborative learning and capacity building models in continuing medical education and lifelong learning, including the role of academic medical centers, provider organizations and community providers in such education and lifelong learning
The recommendations made in HHS’s report may be used to integrate the Project ECHO model into health systems across the country.
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The ECHO Act is yet another legislative effort aimed at expanding access to quality care to rural and underserved communities through the use of health technology. Congress has introduced a number of bills that address the use of health care technology to increase access and quality of health care, such as the CONNECT for Health Act and the 21st Century Cures Act of 2016 (H.R. 34), in addition to a number of reports and surveys that have been published on all aspects of technology in health care delivery. Further, reimbursement barriers or limitations that have traditionally discouraged the adoption of these types of innovative access-driven models are under scrutiny at the state and federal levels, and recent legislation, including the Medicare Access and CHIP Reauthorization Act (MACRA) and other state and federal initiatives, encourage the use of health care technologies by providers to successfully transition to alternative payment models based on measurable care delivery and population health metrics. Digital health will continue to be a focal point of state and federal legislation as we enter (and move beyond) 2017.