Journal of General Internal Medicine

, Volume 35, Issue 1, pp 21–27 | Cite as

A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care

  • Miriam KomaromyEmail author
  • Judy Bartlett
  • Sarah R. Gonzales-van Horn
  • Andrea Zurawski
  • Summers G. Kalishman
  • Yiliang Zhu
  • Herbert T. Davis
  • Venice Ceballos
  • Xi Sun
  • Martin Jurado
  • Kimberly Page
  • Allison Hamblin
  • Sanjeev Arora
Original Research



A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.


To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases.


Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care.


ECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder.


ECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients’ physical, behavioral, and social issues.

Main Measures

We assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions.

Key Results

ECHO Care was associated with significant changes in patients’ use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care.


ECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions.


ECHO model multidisciplinary primary care teams complex care high-need high-cost patients Medicaid 



The authors thank Chris Ruge CNP, Devon Neale MD, and all ECHO Care team members and teleECHO specialists; John Billings JD and Tod Mijanovich PhD (NYU) for Medicaid claims analysis guidance; Jennifer Snead PhD (ECHO Institute) for manuscript preparation support; Mark Larson (Center for Health Care Strategies); Nancy Smith Leslie, the NM State Medicaid Director, and the NM Medicaid MCOs. This work was supported by the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (Grant Number: 1C1CMS330973-01-00). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. HHS or any of its agencies. The research presented was conducted by the awardee. Findings may or may not be consistent with or confirmed by the findings of the independent evaluation contractor.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5206_MOESM1_ESM.docx (101 kb)
ESM 1 (DOCX 101 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Miriam Komaromy
    • 1
    Email author
  • Judy Bartlett
    • 2
  • Sarah R. Gonzales-van Horn
    • 3
  • Andrea Zurawski
    • 3
  • Summers G. Kalishman
    • 3
  • Yiliang Zhu
    • 4
  • Herbert T. Davis
    • 4
  • Venice Ceballos
    • 3
  • Xi Sun
    • 3
  • Martin Jurado
    • 3
  • Kimberly Page
    • 4
  • Allison Hamblin
    • 5
  • Sanjeev Arora
    • 3
  1. 1.Medical Director, Grayken Center for Addiction, Boston Medical Center, Boston UniversityBostonUSA
  2. 2.Division of General Internal Medicine, Department of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueUSA
  3. 3.University of New Mexico Health Sciences Center, ECHO Institute™AlbuquerqueUSA
  4. 4.Division of Epidemiology, Biostatistics and PreventionUniversity of New Mexico Health Sciences CenterAlbuquerqueUSA
  5. 5.Center for Health Care Strategies, Inc.HamiltonUSA

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