July | August 2017





Missouri Looks to New Telehealth Model

By Debra Miller, CSG Director of Health Policy
Missouri Rep. Diane Franklin came into office in 2010 with a keen interest in health care. It was destiny.
She manages the office for her physician husband and is the mother of a physician. She had worked campaigns for her predecessor, Wayne Cooper, also a physician, and followed him into office when he reached his term limit.
Last summer, Franklin sat on a committee that travelled the state to listen to people’s concerns about health care and, more specifically, Medicaid. She said it became clear “we need something that delivers care.”
Missouri has not opted to expand Medicaid, but, Franklin said, “my side of the aisle is looking for cost-effective solutions that improve client outcomes. I would love not to create more bureaucracy.”
Now, Franklin is leading the charge to replicate in her home state the highly regarded ECHO Project at the University of New Mexico. ECHO expands the capacity to provide best practice care for common and complex diseases in rural and underserved areas, founder and director Dr. Sanjeev Arora said during a full day ECHO orientation program in December.
Arora calls ECHO a force multiplier, with a goal to “de-monopolize the knowledge of medical specialists.”
Unlike the traditional telemedicine model, where patient and provider are linked via technology, ECHO links primary care providers to specialists and, through consultation and education, builds the capacity of those primary care providers to offer the latest evidence-based treatments for their patients.
Franklin completed her due diligence on ECHO, including participating in a video conference with Arora and attending a CSG health policy academy where the ECHO program was featured, before organizing a trip to New Mexico to see the program in operation.
Franklin, Rep. Jeff Messenger and former Rep. Wayne Cooper, as well as Dr. Karen Edison and Rachel Mutrux, both affiliated with the University of Missouri telehealth network, attended the December orientation program to learn more about bringing the program back to their state.
During that visit, the Missouri delegation observed a two-hour TeleECHO clinic for hepatitis C, Arora’s specialty. Primary care providers were linked via teleconference to the hub in Albuquerque, where Arora, a mental health professional and a pharmacist—all experts in hepatitis C care—were at the table. The providers, who can number up to about 15, present their patients’ cases and ask for advice on treatment.
Each teleconference includes a 20-minute educational component presented by the Albuquerque specialists. The primary care providers—which include physicians, nurse practitioners and physician assistants—are voluntarily involved in the program. No fees are charged. The providers receive free continuing education credits.
The Missouri observers asked what motivated the involvement of community providers. Besides the free CEUs, providers improve their skills, save their patients long-distance drives to specialty care and participate in an active learning community.
“We have made a lot progress since that site visit in December,” Franklin said. “We are in contact with health care organizations across the state and they see it as a win.”
Franklin expects to make a budgetary request so the University of Missouri can begin to replicate the ECHO program. She said there are ongoing conversations with the Missouri Foundation for Health to join in as a private partner. The foundation may jumpstart funding before the next budget year, as well as provide ongoing support.
Another possible funding avenue could be the Medicaid managed care contracts, where Medicaid managed care organizations could contribute funding on a per member, per month basis.
Arora will visit Missouri later this month and conduct grand rounds at the University of Missouri hospital. He will meet with the existing telehealth network officials about expanding their program and travel to Jefferson City to meet with legislators.
“It is exciting to see things move forward,” Franklin said.



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