Hatch, Schatz Introduce Bill Increasing Access to High Quality Health Care in Remote Regions

Washington, D.C.—Senators Orrin Hatch (R-UT) and Brian Schatz (D-HI) issued the following statements after introducing the Expanding Capacity for Health Outcomes (ECHO) Act, which will increase access to high-quality health care in hard-to-reach regions.

“In states with large rural populations like Utah, it’s vital that we do everything we can to ensure that patients have access to quality health care—no matter where they live,” Senator Hatch said. “By using technology to connect patients and providers, this bill will benefit Utahns living in rural areas by helping them receive the care they need.  I’m grateful for the valuable input Utah’s health leaders have provided in crafting this proposal, and I hope the Senate will act quickly to advance this critical legislation.”

“Technology has the potential to transform how we train doctors and deliver health care,” said Senator Schatz.  “Our bill would help connect primary care providers in underserved areas with specialists at academic hubs, making it easier for medical professionals to access the continuing education they need and provide health care to more people.” 

Statements of Support

Dr. Barbara McAneny, Immediate Past Chair of the American Medical Association:


“Project ECHO is bridging geographic divides to connect physicians and experts with patients in underserved, rural areas. An exemplary model of using new technologies to improve patient care, Project ECHO has potential to bolster access to specialists, reduce incidence of chronic disease, and rein in costs through reduced travel and fewer ER visits. The AMA believes the ECHO Act would provide policymakers with critical information to expand such models to improve clinical practice,” said Dr. Barbara McAneny, Immediate Past Chair of the American Medical Association.” 

Dan Hawkins, Senior VP, Public Policy and Research, National Association of Community Health Centers:

“The Expanding Connectivity for Health Outcomes (ECHO) Act is a bipartisan and innovative response to the need to connect primary care providers to specialists in rural and underserved areas.  Because health centers are all located in medically underserved urban and rural areas or serve medically underserved populations, they regularly become the medical home for patients with complex needs and chronic conditions.  This need is often amplified in rural areas which may have higher rates of chronic diseases and less access to specialty providers. By connecting specialists with primary care providers, the Project ECHO model allows for patients to access quality care close to home and creates opportunities for primary care physicians to manage complex needs in their own health centers. We applaud the efforts of Senator Hatch and Senator Schatz to examine the use of, and opportunities to use, technology-enabled collaborative learning and capacity building models, such as Project ECHO, to improve patient care and provider education.”

Dr. Sanjeev Arora, M.D., Founder and Director, Project ECHO, University of New Mexico School of Medicine:

“Medical knowledge is exploding, but it’s often not traveling the last mile to ensure that patients get the right care in the right place at the right time. If we can leverage technology to spread best practices through case-based learning and mentoring of providers, we can move knowledge – instead of patients – to get better care to rural and underserved communities across the country.”  

Dr. Vivian Lee, CEO of University of Utah Health Care, Dean of the University of Utah School of Medicine, and Senior Vice President for Health Sciences of the University of Utah, on the ECHO Act:

“As the only academic medical center serving five states in the mountain west region, we provide the care and expertise to improve quality of life for many urban, rural, and frontier populations. The ECHO Act legislation will increase access to high-quality health care for both patients and providers in many hard to reach regions, improving the care of rural populations and expanding the medical knowledge of providers who are closest to them. This legislation will help us, as a regional health system, reach and better care for a number of medically underserved populations.”

Dr. Carrie Byington, MD, and Dr. Will Dere, MD, FACP—Co-Directors, Utah Center for Clinical and Translational Science on Project ECHO:

“We have seen the additional benefit of ECHO for increasing the access of individuals in rural or other underserved areas to clinical trials. We have worked to evaluate new methods of prenatal care and we see opportunities to bring cancer clinical trials and other potentially life-saving trials to our state.” 

Dr. Kelley Withy, MD, PhD, Director of the Hawaii/Pacific Basin Area Health Education Center, John A. Burns School of Medicine, University of Hawaii

“Hawaii launched two ECHO clinics only three months ago and we've already provided over 100 hours of continuing medical education and we have had inquiries to start four more ECHO clinics on important local topics. Healthcare providers love it because they are learning by discussing interventions to help their own patients. It's very gratifying and a win-win all around.” 


Rural Health Challenges

  • Only about 10 percent of physicians practice in rural areas of the United States despite nearly one-fourth of the population living in these areas. 
  • Rural areas have higher rates of some chronic diseases and face many challenges, including transportation, connectivity, and isolation.
  • It is difficult to recruit health care providers to work in rural and underserved areas, and opportunities for professional development and support in such areas can be difficult. 

Project ECHO Model

  • Project Extension for Community Health Outcomes (ECHO) is an innovative continuing medical education model that uses interactive videoconferencing to link specialist teams (“hubs”) with primary care providers (“spokes”) in rural and underserved areas. Together, they participate in weekly teleECHO clinics that combine didactic teaching with mentoring and case-based learning.
  • Demonstrated uses of Project ECHO have been numerous and include:
    • Addressing disease conditions and topic areas, including hepatitis C, integrated addictions and psychiatry, chronic pain/headache management, and diabetes;
    • A complex care program offering support to multidisciplinary teams providing primary and behavioral health care to high-need, high-cost patients; and
    • Public health interventions, including addressing H1N1, HIV, and tuberculosis as well as improving health and wellness within Native American populations. 

Benefits of Project ECHO model for:

  • Patients: Improved access to quality and accessible care, with high-patient satisfaction
  • Providers: Increased knowledge for providers in rural/underserved areas, with ability to serve as a local resource; improved provider network; enhanced professional satisfaction and reduced isolation; more access to specialists.
  • Health care system: Higher retention of providers in rural/underserved areas; better care delivered in the right place at the right time by the right person; decreased costs (less travel for specialty visits, less hospitalizations and ER visits, better quality of care close to home, and treatment of chronic diseases earlier before complications arise).
  • Current health care challenges: Project ECHO has successfully been used to increase the number of physicians able to prescribe buprenorphine for opioid abuse, to quickly educate health providers on public health crises such as H1N1, and to train providers to address complex mental health disorders. 

The Enhancing Capacity for Health Outcomes (ECHO) Act:

  • The ECHO Act aims to better integrate the Project ECHO model—referred to as a “technology-enabled collaborative learning and capacity-building model”—into health systems across the country.  The bill does the following:
    • Requires the Secretary of the U.S. Department of Health and Human Services (HHS), in collaboration with the Health Resources & Services Administration (HRSA), to prioritize analysis of the model, its impacts on provider capacity and workforce issues, and evidence of its effects on quality of patient care.
    • Requests a GAO report regarding opportunities for increased adoption of such models, efficiencies and potential cost savings from such models, ways to improve health care through such models, and field recommendations to advance the use of such models.
    • Requires the HHS Secretary to submit a report to Congress on the findings of the GAO report and the HHS report, including ways such models have been funded by HHS and how to integrate these models into current funding streams and innovative grant proposals.