Sanjeev Arora, MD, FACG, MACP

Sanjeev Arora, MD, FACG, MACP is the Director and Founder of Project ECHO (Extension for Community Healthcare Outcomes). He is a Distinguished Professor of Medicine with tenure in the Department of Internal Medicine at University of New Mexico Health Sciences Center. Dr. Arora developed the ECHO model as a way to dramatically improve both capacity and access to specialty care for rural and underserved populations. This is accomplished by linking expert inter-disciplinary specialist teams with primary care clinicians through teleECHO clinics, where the experts mentor primary care clinicians to treat complex conditions via guidance, feedback and didactic education. This helps rural clinicians develop knowledge and self-efficacy so they can adopt research findings and deliver best practice care.

The first teleECHO clinic was developed in 2003 to respond to a growing health crisis hepatitis C and has since expanded to cover over 60 disease areas and complex issues at over 100 academic medical centers in 21 countries. The Centers for Disease Control and Prevention and the Department of Defense have also adopted the ECHO model to enhance access to specialty care. In 2007, Project ECHO came in first among more than 300 entries from 27 countries in winning the Changemakers award. This international competition was sponsored by the Robert Wood Johnson Foundation (RWJF) and Ashoka Foundation to identify programs that are changing the paradigm of how medicine is practiced.

In 2011, ECHO published a prospective cohort study in the New England Journal of Medicine, to prove that treatment for HCV by primary care providers using the ECHO model is as safe and effective as treatment by specialists at an academic medical center.

Over the last 13 years, Dr. Arora has received more than 65 million dollars of grant support. Dr. Arora has been awarded numerous prestigious awards including: the Teresa Heinz and the Heinz Family Foundation 19th Heinz Award for Public Policy, the Second Rosenthal Award from the Rosenthal Family Foundation, the Presidential Award of Distinction from the University of New Mexico and the American College of Physicians and the American Telemedicine Association (ATA) President’s Award. Dr. Arora was also recognized during World Hepatitis Day 2014, at the White House in Washington DC, as a leader in advancing efforts to address viral hepatitis and the goals of the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis.

In very recent developments, the ECHO Act, initiated by ECHO partners across the U.S., was passed unanimously through both houses of Congress and signed into law by President Obama on December 14, 2016. This legislation mandates and empowers two federal agencies (the General Accounting Office, or GAO, and the Health Resources and Services Administration, or HRSA) to study the impact of Project ECHO on the U.S. health system, and will serve to lay the pathway for sustainable funding of the model.

 Interview with Dr. Arora

Tell me a little bit about Project ECHO.

Project ECHO began in 2003, 14 years ago, and has set a goal to touch the lives of one billion people by 2025. Currently, there are more than 115 “hubs,” or academic medical centers and other partners, using the ECHO model in 22 countries around the world.

Just a few months ago we launched a major new initiative to emphasize the ECHO model for cancer, with the aim to improve cancer care through the entire continuum: prevention, early diagnosis, links to care, the latest treatments including cancer genetics and genomics. The idea is to recruit other cancer centers worldwide to use the ECHO model to bring healthcare to underserved people.

How would you characterize innovation that you’ve seen in prevention, treatment, and along the cancer continuum? What is something that you’ve come across expanding ECHO into cancer care?

Throughout the cancer care continuum, there are massive innovations underway. For example, the human papillomavirus vaccine can prevent the vast majority of cervical cancers. The hepatitis C treatment, which now cures nearly 100% of patients, was developed only three to four years ago and now can prevent the vast majority of liver cancers in patients with hepatitis C.

I think that the sad part of the story is, of course, that even very old interventions like colon cancer screening, which has been shown to save lives, are not available to as many as half of the U.S. population. Underserved patients and minorities, in particular, don’t have appropriate access. This happens in both rural and urban areas. Even though there is huge growth in the amount and value of innovation, often these innovations are not delivered to the last mile of health care. The ECHO model can profoundly change lives by allowing health care providers at many different levels to share best practices in an interactive format, building a community of practice that can help to ensure the right knowledge is available to the right patients at the right time.

Since one of our major focuses is communication, how would you characterize nationwide and worldwide communication efforts when it comes to cancer?

In my view, national and worldwide communication efforts are very poor when it comes to cancer. In developing countries and in the United States, so much of the focus has remained on the development of new drugs and treatments. While that is certainly where the economic incentive lies, even the most basic interventions that have been shown to change the game in cancer prevention, screening, and care in a cost-effective manner are not being used in an efficient or appropriate way.

There is also a tremendous fear among the general public about cancer. If you talk to the average person on the street, especially in rural areas, they will often express a great fear about the devastating effects of cancer. But little is understood about the interventions available to prevent cancer or mitigate the effects of cancer. New and better ways are needed to spread all of the tremendous knowledge and scientific discoveries in cancer prevention and treatment so that disparities don’t get worse as science continues to advance.

What are some of the biggest challenges when it comes to cancer for the public health sector, and what are some of the biggest opportunities?

The biggest opportunity in cancer is to prevent it. That is also the biggest challenge. The vast majority of colon cancer is preventable if we are able to screen for it. Simple stool tests can actually prevent and detect colon cancer, and should be a big focus of our work in colon cancer, I believe.

I think the second biggest challenge in our country is ensuring that the health disparities are not made worse with the increase in knowledge, and also helping to make sure that everyone has access to the latest and greatest cures, technologies, and treatments. Creating more opportunities for equity in cancer is definitely another public health challenge.

How would you hope that people’s lives would be changed because of the work you’re doing?

What we are trying to create is a new operating system for health care, for making health care more equitable. That means that essentially we are trying to develop a strategy that will take all types of innovation into the last mile of health care. Several years ago, a study was released that said it can take up to 17 years for knowledge to reach the last mile of health care. We want to compress that, so that once innovation occurs, geography or economic factors do not determine who can access and benefit from the innovation.

Traditionally, the model has been that patients have to move from a rural area to an urban area to actually get care, and that just doesn’t work for most people. Also, the urban centers have long wait lists. Through the ECHO model, we can move knowledge instead of moving patients, ensuring that all can have access to the latest and greatest innovations.

What would you like people to take away from a national cancer conference?

I certainly would want the conference attendees to take away that we as a world have to have a greater focus on prevention of cancer. Second, I think that I’d like them to take away the idea that equity is as important as innovation. It’s not just about doing new and better things, it’s about raising all boats, instead of just a few.