OHA Prepares Statewide RFP to Implement Tele-mentoring and Reduce Specialty Referrals

The Oregon Healthcare Workforce Committee probed Oregon’s foray into “tele-mentoring” through Project ECHO, developed at the University of New Mexico Health Sciences Center to increase access to specialty treatment in rural and underserved areas by giving front-line clinicians support to manage patients with complex conditions such as hepatitis C, rheumatoid arthritis, chronic pain and behavioral health disorders.

In 2013, HealthShare used some of its transformation dollars to launch a Project ECHO pilot on psychiatric medication management with Oregon Health & Science University.

Now a second “cohort on Oregon’s North Coast has launched with Columbia Pacific CCO taking the lead.

Soon the Oregon Health Authority will put out an RFP that will enable the ECHO efforts statewide so that rural clinicians can treat patients in their own communities rather than make referrals to specialists in metropolitan areas, said Chris DeMars, director of systems innovation for OHA’s Transformation Center.

“What’s the ticket to entry to ECHO?” asked Dr. Robyn Dreibelbis, who practices in Lebanon and is vice-chair of the workforce committee. Outreach and information to clinicians is still to come, Boslaugh responded.

It’s essential that the savings achieved by reducing referrals be quantified, said Dr. Carla McKelvey of Coos Bay.

Currently Medicaid cannot be billed for provider-to-provider consultation. Both HealthShare and Columbia Pacific pay for tele-mentoring using their own funds.

Dr. Alisha Moreland, a Portland psychiatrist and chief medical officer for Volunteers of America, questioned who would be billed if a psychiatrist consults with a primary care physician. She also suggested that alternative payment models be developed after data has been collected on the increase in clinician confidence and the decreases in referrals and emergency room visits.

The workforce committee also heard about data collection underway and a stakeholder engagement process regarding provider incentives. With the passage of HB 3396, the Legislature expects a report on the effectiveness of tax dollars to recruit and retain doctors, nurses and other providers in rural and medically underserved areas.

In 2015, state and federal spending on provider incentives topped $26 million in Oregon -- $11.6 million on loan repayments, $8.5 million in tax credits to rural practitioners, $3.35 million in loan forgiveness and $2.5 million in rural medical practitioner insurance subsidies. Jan can be reached at janjohnson6@earthlink.net

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