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Worst-Off Patients Get More Help

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An $8.5 million federal grant will test a plan developed by University of New Mexico physicians to cut Medicaid costs by providing better care for the program’s sickest and costliest patients.

The program is intended to provide intensive treatment for some 5,000 of the sickest Medicaid patients in New Mexico and Washington state by giving primary care practitioners access to a team of specialists via the Internet.

Health plans that manage New Mexico’s Medicaid program will identify about 2,500 of the state’s sickest patients for the program.

The program will build on a model developed by an 8-year-old telemedicine program called Project ECHO, which allows rural practitioners to treat patients with complex illnesses, such as hepatitis C and HIV/AIDS, under the guidance of top specialists.

“The whole nation is struggling with the problem that a small number of patients account for a huge amount of cost,” said Dr. Sanjeev Arora, a UNM physician.

Arora formed Project ECHO in 2003 to expand the reach of his hepatitis C practice.

Medicaid is a government-funded health insurance program for the poor. New Mexico’s expects to pay $870 million in state funds and $3 billion in federal funds this year for 560,000 people – primarily low-income children, elderly and disabled adults.

Nationwide, 1 percent of Medicaid patients account for 22 percent of the program’s cost, Arora said.

The goal of the three-year program is to save Medicaid at least $11 million and provide better care for critically ill patients.

Patients with complex illnesses often face long delays getting appointments with specialists, Arora said.

“Because these patients are so complicated and they are seen by so many doctors, there’s no coordinating entity,” Arora said. “Nobody really knows all parts of this story adequately to provide comprehensive care.”

Project ECHO uses a Web-based teleconferencing system that allows primary care clinicians to consult regularly with a team of UNM specialists who will oversee treatment for the patients, he said.

The program will train about 300 medical practitioners at 10 community-based clinics around New Mexico who will provide primary care for the patients, Arora said.

Arora refers to Project ECHO as a “force multiplier” that allows a small group of specialists to recruit local clinicians in the treatment of hard-to-cure illnesses.
— This article appeared on page D1 of the Albuquerque Journal

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