Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings

Eugene M Lewit; Lauren E Figg; Ananta Addala; Stephanie L Filipp; Rayhan Lal; Matthew J Gurka; Jill Boylston Herndon; Michael J Haller; David M Maahs; Ashby F Walker; Project ECHO Diabetes Research Team

doi:10.1007/s13300-022-01364-3

Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings

Diabetes Ther. 2023 Mar;14(3):509-518. doi: 10.1007/s13300-022-01364-3. Epub 2023 Jan 21.

Authors

Eugene M Lewit^{1

2}, Lauren E Figg³, Ananta Addala³, Stephanie L Filipp⁴, Rayhan Lal^{3

5

6}, Matthew J Gurka⁴, Jill Boylston Herndon⁷, Michael J Haller⁸, David M Maahs^{3

6}, Ashby F Walker⁹; Project ECHO Diabetes Research Team

Collaborators

Project ECHO Diabetes Research Team:
David Maahs, Rayhan Lal, Ananta Addala, Lauren Figg, Katarina Yabut, Noor Alramahi, Ana Cortes, Rachel Tam, Dessi Zaharieva, Marina Basina, Katie Judge, Lety Wilke, Korey Hood, Jessie Wong, Jason Wang, Suruchi Bhatia, Marissa Town, Eliana Frank, Michael Haller, Ashby Walker, Eleni Sheehan, Angelina Bernier, Sarah Westen, Hannah Stahmer, William Troy Donahoo, Xanadu Roque, Gabby Malden, Melanie Hechavarria, Stephanie L Filipp, Matthew J Gurka

Affiliations

¹ Department of Health Policy, Stanford University, Stanford, CA, USA. eugenelewit@gmail.com.
² , 2448 Emerson Street, Palo Alto, CA, 94301, USA. eugenelewit@gmail.com.
³ Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA.
⁴ Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA.
⁵ Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA.
⁶ Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA.
⁷ Key Analytics and Consulting, LLC, Sarasota, FL, USA.
⁸ Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA. hallemj@peds.ufl.edu.
⁹ Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.

Abstract

Introduction: Project ECHO Diabetes is a tele-education learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert "hub" teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and "spokes" consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients. We sought to estimate the costs of operating a Project ECHO Diabetes hub, inclusive of diabetes support coach costs.

Methods: Data from Project ECHO Diabetes from June 2021 to June 2022 and wages from national databases were used to estimate hub and diabetes support coach costs to operate a 6-month, 24-session Project ECHO Diabetes program at hubs (University of Florida and Stanford University) and spokes (PCP clinic sites in Florida and California).

Results: Hub costs for delivering a 6-month Project ECHO Diabetes program to five spoke clinics were $96,873. Personnel costs were the principal driver. Mean cost was $19,673 per spoke clinic and $11.37 per spoke clinic patient. Diabetes support coach costs were estimated per spoke clinic and considered scalable in that they would increase proportionately with the number of spoke clinics in a Project ECHO Diabetes cohort. Mean diabetes support coach costs were $6,506 per spoke clinic and $3.72 per patient. Total program costs per hub were $129,404. Mean cost per clinic was $25,881. Mean cost per patient was $15.03.

Conclusion: Herein, we document real-world costs to operate a Project ECHO Diabetes hub and diabetes support coaches. Future analysis of Project ECHO Diabetes will include estimates of spoke participation costs and changes in health care costs and savings. As state agencies, insurers, and philanthropies consider the replication of Project ECHO Diabetes, this analysis provides important initial information regarding primary operating costs.

Keywords: Cost; Diabetes; Diabetes support coaches; Hub; Project ECHO Diabetes; Spoke; Tele-education.

Abstract

Grants and funding