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US taps N.M. mentoring model for physicians

ESPANOLA, N.M. — The heart of an unborn child beat strong and steady through an amplified monitor, as physician Leslie Hayes examined a pregnant 40-year-old who recently was weaned from heroin with help from anticraving medication.

Hayes and her colleagues treat more than 200 patients for drug-use disorders involving heroin and prescription opioid pain medication at a rural clinic in New Mexico’s Espanola Valley, where rates of opioid addiction and mortality are among the nation’s highest.

Hayes’s ability to effectively treat opioid addiction with the medication buprenorphine, which blocks cravings and withdrawal symptoms, would not be possible without years of regular videoconferences with specialists at a major medical center in Albuquerque under a program known as Project ECHO.


The model is being tapped by federal officials now that President Obama has signed legislation aimed at improving patient access to treatments for a variety of diseases and complex conditions, from HIV and diabetes to bone ailments associated with osteoporosis.

Project ECHO’s long-distance training for physicians, their assistants, and nurse practitioners mimics the mentoring that interns and residents receive at elite urban hospitals.

Sanjeev Arora, Project ECHO’s founder, came up with the concept in 2003 when he realized most New Mexicans with hepatitis C were being left without proven treatments, often leading to liver failure and premature death.

His training model has expanded to 57 medical conditions, and Arora sees a unique opportunity to contain the nation’s epidemic of opioid addiction. In 2015, more than 15,000 people died from overdoses involving prescription opioids, while many prescription addicts have transitioned to cheaper heroin.

‘‘There are very few doctors in the country right now to match the scale of the problem,’’ Arora said.

Under the ECHO Act, the US Health and Human Services Department — which oversees Medicare and Medicaid — will review the mentoring programs and look at ways they could be integrated into one of the world’s largest health care systems. The study also is expected to produce suggestions for continued funding.


The outcome will fall largely to the administration of President-elect Donald Trump, who has vowed to replace portions of Medicaid and Medicare that fund federally qualified health centers serving impoverished rural communities.

Bipartisan support for the ECHO legislation came from Republicans, including Senator Orin Hatch of Utah, and Democrats, such as Senator Tom Udall of New Mexico.

Proponents believe the training can result in dramatic cost savings, especially if the health care industry embraces changes that reward treatment outcomes rather than fees for each medical service.

With guidance from the Project ECHO Institute at the University of New Mexico Health Sciences Center, the effort has been used in 30 states and other countries including India, Brazil, Namibia, and Northern Ireland.

New Mexico, with its grinding rural poverty and patients who are cut off from overbooked specialists hundreds of miles away, provided an ideal laboratory for ECHO — short for Extension for Community Healthcare Outcomes.

A peer-reviewed study published in the New England Journal of Medicine in 2011 showed primary care physicians paired with mentors in New Mexico were just as effective in treating hepatitis C as established specialists at the University of New Mexico.