1. Hub Collaboration

2. System Design Considerations..
Demystifying what each other does/expects… Developed 3 clinical subgroups
Medical: Hub and Spoke providers, various medical subspecialties
Clinical/Counseling: Hubs, private clinicians,
Family/Women: children and family specialists, residential providers,
DEA Consultation
Know your specific rules as interpretation changes by region.. Ask permission vs. beg forgiveness!!
Defining Stability for Transfer to a Spoke: Beyond the tools is the mechanics..
Time in Treatment
Stable Dose vs Stable Patient
Define who does what as clearly as possible
Understand each providers risk tolerance
Urine Tox Screens.. What is tested for needs to be communicated
Vermont Department of Health

3. Hub and Spoke Collaborations
Regional Supportive Relationships
Hubs and Spokes have complimentary areas of strength
Including
Ability to Provide High Levels of Structure
Care for Co-occurring Mental Health Disorders
Care for Co-occurring Chronic Disease or Pain
Psychiatric Needs
Expertise with special populations (i.e. women’s services, young adults 18-21)
Vermont Department of Health

4. Hub and Spoke Collaborations
Regional Supportive Relationships
Hubs can take a leadership role:
Consulting with Spokes both formally and informally
Promoting the availability of a hub as a higher level of management to
Induct & maintain unstable patients
Re-stabilize patients who are struggling (including diversion)
Changing medications if patient is unable to control diversion
Ideally NO wait time for Spoke-transferred patients
Our clients have now changed, providers are our clients and have equal status
“Never have a second chance to make a first impression”….
Vermont Department of Health

5. Hub and Spoke Collaborations
Improve Communication to Improve Transfers
Spokes may remain involved in a patients’ care if the temporarily transfer to a Hub
Spokes can help make determinations about when someone is stable enough to transfer back
OUR patients
Agreed upon goals with patient’s aware of expectations
When Hubs and Spokes collaborate, patients step down to the Spoke practice right for their needs
Vermont Department of Health

6. Case Example: Central Vermont Region
Hub: Central Vermont Addiction Medicine
Area Spokes (“Super” Spokes, primary care, and specialty providers)
No wait time for spoke patients
Active Use of a MAT Team to determine the best clinical fit for patients when
Seeking Treatment and
Stepping out into a Spoke
Develop and Maintain relationships to ensure collaboration
Vermont Department of Health

7. Regulatory mumbo-jumbo… and other considerations…
Accept others medical assessments or complete targeted physicals
No time in treatment requirement for Buprenorphine products
Under 18 admissions? Yes/No/Maybe?
Work with your local DEA agents to understand their interpretation of any rules
Minimize barriers to rapid admissions…
Residential admissions… OTP vs other residential providers..
Jail/prison providers: continue MAT vs. restart upon release
Direct referrals to Spokes? If so, how to accomplish? (pre-admission for patients with lesser structural needs)..
Vermont Department of Health

8. Moral of the Story
Hub and Spoke is built on relationships… started 14 years ago… and still building
Knowing the players, their strengths, and limitations
Trusting the players to provide quality care in their own contexts
Reaching out for support to keep patients as stable as possible (Transfer patients before you kick them out)
Developing stakeholder relationships outside any of our normal realms
Assume Benevolence…
There is enough business to go around!!
“All I really needed to know I learned in Kindergarten”
Neither be afraid or too proud to admit you were wrong.. Just adjust as you go..
This IS NOT a physician consultation model, this is an actively engaged physician model.
Vermont Department of Health