A lifeline for rural Americans struggling against the opioids tide
Americans living in rural communities are seven times less likely than those living in cities to have access to the care they need to treat complex conditions, according to the Association of American Medical Colleges. This is especially true for those suffering from opioid abuse disorder, which is having a profound impact in rural areas that also face a shortage of medical professionals with proper training to treat the epidemic.
No one knows this better than Dr. Jonathan Hager, an internal medicine physician from the Rochester area of upstate New York. Help for substance abuse can be hard to find, so the road to treatment often ends at the family doctor’s office. But because opioid use disorders are inherently complex -- particularly when combined with other health conditions -- many physicians like Hagar realize they are not equipped to handle the more complicated cases.
Enter ECHO: A Team of Experts
When Hagar learned about Project ECHO (Extension for Community Health Care Outcomes), a doctor education initiative led by Excellus BlueCross BlueShield to help boost health care professionals’ capacity to treat patients with opioid use disorder, he jumped at the chance to join. There are many ECHOs around the country focused on helping community health care professionals offer more specialty care to patients, particularly in underserved rural communities.
The virtual networking model brings a multidisciplinary team of experts together every other week on a video conference with doctors eager to deepen their skills. Participants have the opportunity to present their own cases, seeking the group’s expertise and input. Dr. Ann Griepp, chief medical officer of behavioral health at Excellus, says ECHO has helped doctors feel less isolated and more confident about handling complicated patients.
ECHO’s Dual Impact
Excellus has taken steps to measure the effectiveness of Project ECHO. In addition to patient benefits, Griepp works to assess how doctors have improved their practices and whether they experience reduced feelings of professional isolation. Feedback from participants in ECHO’s program at the University of New Mexico School of Medicine indicates that ECHO delivers social and professional benefits, providing health care professionals practicing in rural areas with access to a supportive group of peers.
For Hager, the bi-weekly sessions have increased his comfort level with the unknown. “The biggest thing that I’ve taken away,” he says, “is that there’s a lot more gray [area] in this treatment world than black and white.” When Hager presents a case to the ECHO experts, he’s come to accept that there may be no right or wrong answers, but he knows he can tap into the group’s wisdom. “It’s so much more useful than reading about something or having someone lecture you.”
“It's so much more useful than reading about something or having someone lecture you. ” — Dr. Jonathan Hager, internal medicine physician, Rochester, NY
ECHO’s Expansion
Project Echo now addresses more than 100 complex conditions globally. In the United States, more than half of the 429 Project Echo programs are providing support to medical professionals in medically underserved regions. BCBSA supports the expansion of Project ECHO to additional states as a strategy to help ensure that people struggling with opioid use disorder can access the right care in the right setting, no matter who they are or where they live.
Learn more about Blue Cross and Blue Shield company strategies to address the nation’s opioid crisis.
