VA expands specialty care in rural areas

The Department of Veterans Affairs (VA) recently announced it is launching a nationwide specialty health-care program for veterans in rural areas, based on the Project Echo pilot program currently operating at 11 VA medical centers.

The new program, Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO), will give training, advice and support to primary care providers (PCPs) so they can deliver specialty care to VA patients with chronic illnesses such as diabetes, hepatitis C and congestive heart failure.

“The SCAN-ECHO model allows the VA medical community to treat a greater number of patients than the current structure,” said Jacob Gadd, deputy director of health for The American Legion. “In a sense, it takes a primary care provider from saying to the patient, ‘Let me refer you to a specialist,’ to saying ‘I can diagnose and treat your condition.’ It is going to help increase the confidence and competence of PCPs by teaching them best practices for specialty care.”

The effectiveness of the Project Echo/SCAN-ECHO model has been supported by multiple research trials, Gadd said, as well as articles published in “Health Affairs” and “The New England Journal of Medicine.”

Not only will the expanded program improve the continuity of care, it will also:

  • Reduce wait times at specialty clinics,
  • Mitigate difficulties in recruiting specialists for rural areas,
  • Increase certifications for the delivery of specialized medicines,
  • Enhance the professional development and satisfaction of PCPs, and
  • Build local, sustainable centers of medical excellence.

Brian Bertges, the Legion’s assistant director of policy research, said that SCAN-ECHO may also produce some indirect savings. “Since the program targets access for rural veterans, VA may see a decrease in mileage reimbursements because veterans’ travel time will be reduced.

“VA may also see more savings in the area of fee-based services. Instead of referring veterans to specialists in their local communities, more PCPs in the VA system will be able to provide that kind of care,” Bertges said.

Project Echo has been supported by a three-year, $5 million grant from the Robert Wood Johnson Foundation.