Demystifying what each other doesexpects Developed 3 clinical subgroups Medical Hub and Spoke providers various medical subspecialties ClinicalCounseling Hubs private clinicians FamilyWomen children and family specialists residential providers ID: 688760
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Slide1
Hub Collaboration Slide2
System Design Considerations..
Demystifying what each other does/expects… Developed 3 clinical subgroups
Medical: Hub and Spoke providers, various medical subspecialtiesClinical/Counseling: Hubs, private clinicians, Family/Women: children and family specialists, residential providers,DEA ConsultationKnow 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 TreatmentStable Dose vs Stable PatientDefine who does what as clearly as possibleUnderstand each providers risk toleranceUrine Tox Screens.. What is tested for needs to be communicated
Vermont Department of HealthSlide3
Hub and Spoke Collaborations
Regional Supportive Relationships
Hubs and Spokes have complimentary areas of strengthIncludingAbility to Provide High Levels of StructureCare for Co-occurring Mental Health Disorders
Care for Co-occurring Chronic Disease or PainPsychiatric NeedsExpertise with special populations (i.e. women’s services, young adults 18-21)
Vermont Department of HealthSlide4
Vermont Department of Health
Hub and Spoke Collaborations
Regional Supportive RelationshipsHubs can take a leadership role:Consulting with Spokes both formally and informallyPromoting the availability of a hub as a higher level of management to
Induct & maintain unstable patientsRe-stabilize patients who are struggling (including diversion)Changing medications if patient is unable to control diversionIdeally 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”…. Slide5
Hub and Spoke Collaborations
Vermont Department of Health
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 needsSlide6
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 whenSeeking Treatment andStepping out into a SpokeDevelop and Maintain relationships to ensure collaboration
Vermont Department of HealthSlide7
Regulatory mumbo-jumbo… and other considerations…
Accept others medical assessments or complete targeted physicals
No time in treatment requirement for Buprenorphine productsUnder 18 admissions? Yes/No/Maybe?Work with your local DEA agents to understand their interpretation of any rulesMinimize 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 HealthSlide8
Moral of the Story
Hub and Spoke is built on relationships… started 14 years ago… and still building
Knowing the players, their strengths, and limitationsTrusting 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 realmsAssume 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