Scaling Up Project ECHO in New York State

Grantee Name

University of Rochester;
New York Academy of Medicine;
Research Foundation for the State University of New York

Funding Area

Special Projects Fund

Publication Date

November 2020

Grant Amount

University of Rochester: $344,484 (2014); $50,000 (2017);
New York Academy of Medicine: $57,730 (2016);
Research Foundation for the State University of New York: $100,000 (2018)

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In rural areas of New York, primary care physicians must serve as specialty care providers because of shortages in physician supply.

Originated at the University of New Mexico in 2003, Project ECHO increases access to specialty treatment for patients in rural and underserved areas by providing frontline physicians with the knowledge and support they need to manage patients with complex conditions. The model engages physicians at “spoke” sites (e.g., sites in rural areas) in a continuous learning system and virtually partnering them with an interdisciplinary team of specialist mentors (e.g., psychiatry, nursing, social work, psychology, pharmacy) at an academic medical center, known as a “hub.”

NYHealth awarded a series of grants to support the development and scale-up of Project ECHO models throughout New York State.

Outcomes and Lessons Learned

Launched the first-ever Project ECHO in New York State: Project ECHO Geriatric Mental Health (ECHO GEMH), through which primary care providers from eight rural counties in New York State received telementoring from geriatric specialists. Among the outcomes:
- ECHO GEMH initially aimed to involve 75 participants in 8 counties. By the end of the grant, it had grown to 500 participants across 32 counties.
- A complementary evaluation of ECHO GEMH, funded by the Health Foundation for Western & Central New York, showed promising results in the improvement of primary care providers’ geriatric mental health skill sets, as well as statistically significant reductions in emergency room visits and costs.
Supported the New York Academy of Medicine, with co-funding from GE Foundation, to develop the first-ever evaluation toolkit and resource guide in 2016, geared toward nonacademic users of Project ECHO. There was and continues to be a great demand for the toolkit, both in New York State and across the nation.
Supported the expansion of an existing ECHO clinic at SUNY Upstate to launch a sickle cell disease ECHO clinic in 2018. The project aimed to reach 150–200 sickle cell patients in the region. It has been delayed by COVID-19, but is still underway. It has already established ECHO clinics in at least five emergency departments and has connected with providers in seven upstate counties.
Supported the expansion of a Project ECHO clinic in general psychiatry (ECHO PSYCH) in 2017, as well as a robust quality/cost-effectiveness evaluation in partnership with Excellus BlueCross BlueShield with the following outcomes:
- The first ECHO PSYCH clinic was launched in March 2016; as of December 2019, there were 37 clinics that had seen a total of 790 patients.
- The ECHO PSYCH evaluation found statistically significant reductions in emergency room utilization and costs.

The evaluation’s results helped the University of Rochester Medical Center (URMC) achieve sustainable funding for ECHO PSCYH. Accountable Health Partners now fully funds ECHO PSYCH, making it the first Project ECHO clinic to be entirely self-sustainable.

Because of Project ECHO’s success, the New York State Department of Health (NYSDOH) announced a funding opportunity for replicating and scaling the model throughout the State, recognizing Project ECHO as a preferred model for the Delivery System Reform Incentive Payment (DSRIP) program. This endorsement of Project ECHO fueled an even stronger demand for a statewide expansion of Project ECHO. In 2017, NYSDOH announced a Project ECHO Model Expansion Request for Applications to expand the model statewide. More than $845,000 was awarded to four New York State providers: Champlain Valley Physicians Hospital, Montefiore Medical Center, SUNY Upstate Medical University, and Westchester Medical Center Health Network. NYSDOH also encouraged awardees to use the NYHealth-funded evaluation toolkit to measure outcomes and successes.

Project ECHO is an excellent example of why it is important for funders to take the long view when investing in projects with potential for enormous impact. NYHealth funding helped establish the first Project ECHO clinic in New York State in 2014; since then, the model has experienced unprecedented growth and gained many partners. The U.S. Department of Health and Human Services released a report in 2019, “Report to Congress: Current State of Technology-Enabled Collaborative Learning and Capacity Building Models,” noting that New York State ranked third in the number of Project ECHO programs in operation. NYHealth’s long-term commitment—both financially and otherwise—is widely recognized as instrumental in growing and sustaining the Project ECHO model both within URMC and throughout the State.

Co-Funding and Additional Funds Leveraged: Collectively, this project has leveraged more than $23 million for the Project ECHO model in New York State.

2014: Health Foundation for Western & Central New York ($50,000).
2016: New York State Department of Health ($850,000); New York State Department of Health/St. James Mercy Hospital ($510,000); GE Foundation ($55,000 in co-funding and $16 million to establish ECHO sites nationwide).
2017: Greater Rochester Health Foundation ($850,000); Ira Davenport Memorial Hospital ($27,400); Finger Lakes Performing Provider System ($961,113); Health Foundation for Western & Central New York ($25,000); University of Rochester Medical Center ($25,000); New York State Office of Mental Health ($352,544).
2018: Health Resources & Services Administration ($2.5 million).

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