Evaluating the Economic Impact of Project ECHO Diabetes: Cost Savings from HbA1c Reduction in Type 1 and Type 2 Diabetes

Noah Hammarlund; Ara Jo; Ashby F Walker; Michael J Haller; David M Maahs; Benjamin Churba; Keilecia G Malden; Molly Jacobs

doi:10.1016/j.eprac.2025.06.025

Evaluating the Economic Impact of Project ECHO Diabetes: Cost Savings from HbA1c Reduction in Type 1 and Type 2 Diabetes

Endocr Pract. 2025 Jul 3:S1530-891X(25)00940-1. doi: 10.1016/j.eprac.2025.06.025. Online ahead of print.

Authors

Noah Hammarlund¹, Ara Jo², Ashby F Walker³, Michael J Haller⁴, David M Maahs⁵, Benjamin Churba², Keilecia G Malden², Molly Jacobs²

Affiliations

¹ Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA. Electronic address: noah.hammarlund@ufl.edu.
² Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
³ Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA; University of Florida Diabetes Institute, Gainesville, Florida, USA.
⁴ Division of Endocrinology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA; University of Florida Diabetes Institute, Gainesville, Florida, USA.
⁵ Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, California, USA.

PMID: 40617393
DOI: 10.1016/j.eprac.2025.06.025

Abstract

Objectives: Elevated HbA1c levels (>9%) increase the risk of complications and drive higher healthcare costs, particularly in communities with limited access to specialty care. Project ECHO Diabetes offers a scalable tele-education model to empower primary care providers in delivering effective diabetes management. This study assessed the economic impact of Project ECHO Diabetes by estimating healthcare cost savings from reductions in HbA1c levels >9% and comparing these savings against program costs.

Methods: A stepped-wedge design was used to implement Project ECHO Diabetes across Federally Qualified Health Centers (FQHCs) in California and Florida between 2021 and 2022. Data were collected before and after the 6-month intervention to assess HbA1c changes, with healthcare cost savings estimated using established literature and adjusted to 2023 USD.

Results: The study included 32,796 adults with Type 1 diabetes (T1D; n=1,127) or Type 2 diabetes (T2D; n=31,669). The intervention consisted of bi-monthly tele-education sessions, real-time medical support, and access to diabetes management resources over six months. The primary outcome was healthcare cost savings derived from HbA1c reductions >9% and comparison with program costs. The proportion of patients with HbA1c >9% decreased from 31.7% to 26.7% for T1D and 24.0% to 18.9% for T2D. Estimated first-year per-patient savings were $3,205.95, with total program savings exceeding $5 million, far outweighing implementation costs of $513,257.

Conclusions: Project ECHO Diabetes achieved substantial cost savings through improved glycemic control, supporting its broader implementation to enhance diabetes care and reduce healthcare costs.

Keywords: Diabetes; Health care costs; Health education; Primary care; Quality improvement; Telemedicine.