Vermont Blueprint’s Hub & Spoke Program Transforms Opioid Addiction Treatment

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May 2017 -- The Vermont Blueprint for Health is a nationally recognized patient-centered medical home program for its advances in primary care and healthcare transformation. One of the Blueprint’s critical initiatives is its “Hub & Spoke” model, a systematic treatment response to the growing epidemic of opioid use disorder (OUD) which effectively bridges the gap between clinic and community settings. With the assistance of Onpoint, the Blueprint recently released a peer-reviewed study and a suite of regional performance profiles that evaluate the Hub & Spoke model’s overall performance.

Under the Blueprint’s Hub & Spoke model – in which the “Hub” consists of regional specialty OUD treatment centers and the “Spoke” of community-based teams of healthcare professionals – each patient undergoing medication-assisted treatment (MAT) has access to an established Health Home, a single MAT prescriber, a pharmacy home, and access to Community Health Team primary care supports as well as to additional Hub and Spoke nurses and clinicians with expertise in OUD treatment. 

Over the past year, the Blueprint and Onpoint teams have been working on several multi-source data projects in support of the Hub & Spoke model aimed at evaluating the progress made in quality of care, utilization, and cost of MAT-related services. Essential utilities behind these evaluation and analytic capabilities include the Blueprint Clinical Registry (formerly DocSite) and the statewide all-payer claims database (known as the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES)). In addition to linking clinical data with the VHCURES all-payer claims data set, the Blueprint is incorporating additional data sources (e.g., Department of Corrections database) to produce an array of process and outcomes measures examining the OUD population.

First, a study conducted by the Blueprint, published in the Journal of Substance Abuse Treatment, assesses Vermont’s Medicaid utilization and medical service expenditures for those receiving MAT compared to those receiving substance abuse treatment without medication, effectively providing a baseline evaluation. In the study’s conclusion, the authors suggest that Vermont's expansion of MAT services for the Medicaid population “has the potential to produce better opioid addiction treatment results and lower overall healthcare costs compared to other approaches to opioid addition treatment.” For state Medicaid leaders looking to fight the opioid epidemic, the study provides a compelling case to offer early support for expanding MAT services rather than relying solely on "time-limited medication" or psychosocial and abstinence interventions. 

Using the study as a baseline, the Vermont Blueprint next began to closely evaluate the Hub & Spoke model’s efforts in linking greater access to MAT with a network of primary and community services. To accomplish this, the Blueprint expanded its suite of profile reporting at the health service area and primary care practice setting to generate additional outcomes-based analyses at the hub, spoke, and program-wide levels. This first-in-the-nation reporting on the OUD population effectively allows regional specialty OUD treatment centers, teams of healthcare professionals, and program leaders alike to compare the model’s individual settings (i.e., health service area, primary care practice) to its peers across a broad range of performance metrics – all in an effort to help combat the rising opioid epidemic.

In addition to demographic, health status, and other comorbid condition information, the Hub & Spoke regional profiles report the “Adult Medicaid Core Measures,” also known as the core “Health Home Measures.” This measure set includes a combination of claims-based and hybrid (i.e., claims and clinical) measures (e.g., Healthcare Effectiveness Data and Information Set (HEDIS) and Physician Quality Reporting System (PQRS) national metrics) that can be used to evaluate health services across many conditions.

With the linked claims and clinical data more powerful than either data set alone, the multi-source data evaluation and reporting conducted by the Blueprint in support of its Hub & Spoke model plays a critical role in health systems, and overall health improvement in Vermont. Leveraging the Blueprint’s evaluations, program leaders and policymakers alike are being given the data needed to better understand and address root causes that may be contributing to the growth in OUD and overdose deaths and the related escalating healthcare and social costs of the crisis.