Physicians and other medical experts in New Jersey are teaming up to bring more specialized care to people living in rural areas on Medicaid who lack comprehensive health insurance coverage.
Robert Wood Johnson Partners launched the New Jersey Project ECHO Academic Medical Center Hub in the fall with three remote-access “tele-mentoring” clinics. The program has picked up speed as participating primary-care physicians and specialists work in hepatitis C treatment, pediatric mental health and endocrinology.
The hub project aims to educate and train local primary care physicians with help from specialists so they can treat more complex cases without referring patients to those specialists. Organizers say this will expand access to specialized care for underserved patient populations and save people money.
“It saves the patient trips and allows primary-care physicians to take more complete care of patients,” said Dr. Vinod Rustgi, Clinical Director of Gastroenterology and Director of Hepatology at Robert Wood Johnson Medical School. “What it allows is the point of contact for care to happen earlier.”
About 2.8 million New Jersey residents were living in true poverty, or at 250 percent of the federal poverty level, in 2014, according to a recent Anti-Poverty Network of New Jersey report. The Rutgers Council of Teaching Hospitals found, however, that the state has a low percentage of doctors who accept Medicaid patients.
With limited options, Rustgi said paying to go see a specialist had become unrealistic for many, resulting in a group of people who could not afford to get preventative or early care for conditions and diseases that would get worse without treatment.
“If they go see a specialist, there are often higher co-pays and costs in addition to having to make extra trips,” Rustgi said. “This program saves them money, time and travel distance. Now, if they are in Atlantic City, they don’t have to travel all the way to me, but they still get quality specialty care through their primary doctor.”
Primary care physicians can sign up for Project ECHO and attend free weekly education remote clinics from their offices, homes and other locations.
New Jersey’s program offers clinics in three areas of treatment: hepatitis C; autism, ADHD and pediatric mental health; and advanced endocrinology. Sessions are 90 minutes and include case presentations followed by a 15-minute problem solving session with specialists and other participating physicians.
Primary care physicians stay in contact and work with specialists through Project ECHO’s hub as they see specialty cases. The program does not entirely eliminate the practice of patient referrals as experts say some people may be too far advanced in a disease and will still need to see a specialist in person.
The Newark-based Nicholson Foundation funded New Jersey’s Project ECHO hub with a $1.9 million, two-year grant.
Laura Montenegro, licensed social worker with Robert Wood Johnson Partners, traveled to New Mexico to meet with founders of Project ECHO, which launched in 2003 and has since grown to include 94 hubs in 30 states and 15 countries outside the United States.
She said uninsured and low income people have difficulty accessing healthcare, including people who are in the U.S. without documentation. She hopes the hub will allow those people to get quality specialized care if all they can afford is a visit to their primary care doctor.
Montenegro said she hopes New Jersey’s hub will expand to include clinics for other diseases in the future, but the current ones are a good start.
Isabelle Mosca, executive director of FACES 4 Autism, a support organization based in Atlantic and Cape May counties, knew she had to seek medical help for her 17-year-old son as he began to experience some developmental regression due to a seizure disorder.
Before Project ECHO was brought to New Jersey, Mosca went to her family pediatrician, who had connections to autism specialists through a similar medical hub program at Cooper University Hospital in Camden.
She was able to get help for her son through a familiar local physician without making trips to Camden.
Mosca said families, especially ones in need of autism specialists in South Jersey, may benefit from hub networks like the one at Cooper and New Jersey’s Project ECHO, especially as they grow to include more diseases and age groups.
“One of the most frequent questions asked (at FACES 4 Autism) is about local experts in various fields,” she said. “But physicians who work with Autism Spectrum Disorder adults are very rare in South Jersey. It is a field sorely in need of trained professionals.”