The Washington State Hub and Spoke Model to increase access to medication treatment for opioid use disorders

Abstract

The federal Opioid State Targeted Response (Opioid STR) grants provided funding to each state to ramp up the range of responses to reverse the ongoing opioid crisis in the U.S. Washington State used these funds to develop and implement an integrated care model to expand access to medication treatment and reduce unmet need for people with opioid use disorders (OUD), regardless of how they enter the treatment system. This paper examines the design, early implementation and results of the Washington State Hub and Spoke Model. Methods: Descriptive data were gathered from key informants, document review, and aggregate data reported by hubs and spokes to Washington State's Opioid STR team. Results: The Washington State Hub and Spoke Model reflects a flexible approach that incorporates primary care and substance use treatment programs, as well as outreach, referral and social service organizations, and a nurse care manager. Hubs could be any type of program that had the required expertise and capacity to lead their network in medication treatment for OUD, including all three FDA-approved medications. Six hub-spoke networks were funded, with 8 unique agencies on average, and multiple sites. About 150 prescribers are in these networks (25 on average). In the first 18 months, nearly 5000 people were inducted onto OUD medication treatment: 73% on buprenorphine, 19% on methadone, and 9% on naltrexone. Conclusions: The Washington State Hub and Spoke Model built on prior approaches to improve the delivery system for OUD medication treatment and support services, by increasing integration of care, ensuring "no wrong door," engaging with community agencies, and supporting providers who are offering medication treatment. It used essential elements from existing integrated care OUD treatment models, but allowed for organic restructuring to meet the population needs within a community. To date, there have been challenges and successes, but with this approach, Washington State has provided medication treatment for OUD to nearly 5000 people. Sustainability efforts are underway. In the face of the ongoing opioid crisis, it remains essential to develop, implement and evaluate novel models, such as Washington's Hub and Spoke approach, to improve treatment access and increase capacity.

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

“…Further, patients receiving treatment within Vermont's hub and spoke system reported lower opioid use as well as reductions in overdoses, visits to the emergency department, contact with police, and family conflict and improvements in several areas of life satisfaction and mood [156]. Several states are currently implementing hub and spoke models, including Washington and California [157,158].…”

Financial sustainability of payment models for office-based opioid treatment in outpatient clinics

“…Patients typically receive induction and stabilization at the hub, and are then referred back to the primary care spoke for maintenance, and return to the hub if they destabilize. The hub and spoke model has also been adopted and in some cases modified elsewhere, including in Washington state [ 40 ] and California [ 41 ], sometimes using sites other than OTPs as hubs. In Vermont , s pokes must be staffed by at least one nurse and one mental health counselor per 100 patients [ 42 ].…”

Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana

“…The Hub and Spoke (H&S) model of care delivery was developed to improve access to MOUD within rural communities, with the most notable success being seen in Vermont. 7 It has since been widely adopted for MOUD across other states, 8 , 9 yet detailed studies about the adoption and implementation processes of this model have just recently gained attention, such as those in California. 10 , 11 Yet, little is known about these processes for frontier states like Montana: designated as Frontier and Remote (FAR) by the federal government due to small populations and geographical remoteness.…”

“…The existing evidence-base demonstrates that in most cases, the H&S model has been successful at expanding access to MOUD, particularly in rural contexts. 8 , 9 , 30 However, there remains a gap in the scientific literature about the processes by which an H&S model is implemented within a frontier, rural state, and any associated challenges. This study examines how MOUD providers experienced the roll out of the Hub and Spoke model in Montana.…”