Recently, the US senate has unanimously passed a bill (97-0) that many proponents agree may significantly improve the delivery of healthcare to people who live in rural America. The Expanding Capacity for Health Outcomes (ECHO) Act was initially developed and introduced by Senators Orin Hatch (R-Utah) and Brian Schatz (D-Hawaii). The bill has garnered complete bipartisan support among senators and lawmakers with the hope that this model will markedly improve healthcare services and delivery where there are a few or no healthcare workers.
The aim of the ECHO Act is to integrate the use of technology to help deliver and educate with the help of a collaborative model. The model offers dynamic interactions with specialists through teleportals 24/7 in any part of the country.
Over the past few decades, there has been a major decline in available health services in less populated areas of the country. Patients with acute and chronic health issues often had to travel to larger cities to see a healthcare provider or specialists.
Senators Hatch and Schatz first became aware of this problem in the rural areas of their respective states a few years ago. They quickly became aware that many Americans living in rural areas where to seek to travel; and a better option would be to deliver healthcare to them. They proposed the bill in June 2016 and was passed on November 29, 2016.
Advocates in many states had been pushing for better ways to provide healthcare services to people living in rural areas. Today, at least 25 percent of the American population resides in rural areas but only about 10% of healthcare providers actively work in such areas. This mismatch in healthcare providers and the rural patient population also meant long waiting times for many patients in rural America.
The ECHO project though is not a novel concept. It first evolved at a state level at the University of New Mexico in 2003. The initiative was run by faculty from the Department of Medicine at the University hospital who ran “teleECHO’ clinic in rural areas. These academics not only provided training to the general practitioners but also used videos to assess more complex patients and triaged them accordingly for healthcare service in tertiary care centers.
This concept was then further developed by the University of Utah Health Care, who in turn conducted weekly clinics with community healthcare providers in underserved and rural areas of Mountain West and Utah. With backup from specialists, the local providers were able to look after complex cases and prescribe effective treatment. A similar program was also run by the Health Care services in Hawaii to many of the rural people living on the smaller islands. The success of the Utah Healthcare and Hawaii ECHO program led Senators Hatch and Schatz to make a statewide proposal for all Americans living in rural areas.
There is unanimous agreement between both legislators and healthcare workers in all states that the ECHO Act will help reach and treat the medically underserved population across the nation. Healthcare providers from Utah and Hawaii have been very vocal of the ECHO Act as they have first-hand experience on its benefits to their local communities. The major benefit would be that federal health agencies will be able to prioritize its services and also provide funding. In the long run, this will not only help save costs but also improve patient outcomes.
Some of the services provided by ECHO Act in Utah and Hawaii include prenatal care, education about obesity and heart disease, management of a variety of mental health disorders and introduction of cancer treatment. It will also increase the number of healthcare providers who can now prescribe buprenorphine in individuals who abuse opiates and provide information on public health crises like H1N1 or Ebola virus.
It is hoped that in the long run, this new legislation will help with higher retention of healthcare providers in rural areas by providing them with confidence that back-up is always available if needed. In addition, the ECHO Act will ensure that the most appropriate type of care is delivered to the right person at the right time. By decreasing the cost of travel to visit specialist(s), less frequent hospitalizations and emergency room visits, it will hopefully lead to better quality of care closer to home at low cost.
It is too early to state the benefits of the ECHO Act. While anecdotal reports from patients and healthcare workers do state the advantages, clinical trials and evaluation of the data over the long term will be needed to fully assess the program. Nevertheless, the results of Hawaii and Utah suggest that the program does have the potential to make a positive impact on the lives of millions of Americans. The one major delay to the practicality of the ECHO Act may be the election of Donald Trump as president, as he has set one of his presidency goals to completely overwrite the healthcare system and delivery of healthcare.