Physicians at HealthPartners in Minneapolis–St. Paul, MN, saw an opportunity to improve care for patients with diabetes who were being seen in primary care. In a health system where some clinic locations are up to 90 miles apart, there had to be a better way to leverage the expertise and time of endocrinologists within the system through the transfer of knowledge without moving patients. Intrigued by the University of New Mexico Project ECHO Model, the team at HealthPartners decided to implement a Project ECHO cohort in endocrinology. To learn more, the project leaders, an endocrinologist and a diabetes educator, visited the University of New Mexico for training and ideas on how to implement the model within HealthPartners.
The team identified seven to eight primary care physicians to participate in the initial cohort, which lasted four months and consisted of four sessions with CME credits provided. Time was carved out for participants so they were not expected to do this work in addition to their other responsibilities. Several primary care medical directors were selected to be in the first cohort so they could engage their teams by speaking from experience. The four sessions, each lasting two hours, were facilitated by an endocrinologist leader and a diabetes educator via a live online webinar. A lecture was presented at the beginning of each session. Then, each participating primary care physician would present two cases from his or her practice, soliciting advice and recommendations from the endocrinologist and diabetes educator as well as the other primary care physicians.
Early on, it became evident that the facilitation skills of the endocrinologist and diabetes educator were a key determinant for successful sharing during sessions. It also became clear that certain topics were more relevant to the group than others; for example, for primary care physicians, information around glycemic management was more helpful than instruction on managing lipids. The overall feedback from participants was very favorable, with uniformly positive feedback on the survey. One physician commented that this was the “best CME [he has] ever attended.” Another noted that “patients would have needed to see endocrinology if we were not doing this.” A1C results and cost savings were tracked across the system and were also used as an indicator for success. The average decrease in A1C for the patients in the cohort was 0.7 percent and there was almost a threefold increase in the percent of patients meeting their A1C goal. The team modeled cost savings from decreased office visits to an endocrinologist for diabetic patients, which was estimated to be approximately $100,000 per cohort.
HealthPartners is currently expanding the model to a psychiatry cohort, specifically related to adult anxiety and depression. The cohort just started and the initial feedback is that physicians are finding it helpful, especially in the current market where there is a shortage of psychiatrists. Hypertension is a possible area to be explored next.
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