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Rural Health Information Hub

Hub and Spoke Model

The hub and spoke model is a system of medication for opioid use disorder (MOUD) treatment that involves two levels of care. At hub sites, which are located regionally, patients receive initial intake and management services for MOUD. At spoke sites, which are located within the community, patients receive ongoing treatment, monitoring, and support services.

Hub sites offer more intensive treatment and a full array of services, often at an opioid treatment program (OTP). Often, services delivered at hub sites are coordinated by a case manager or care coordinator. These coordinators can connect patients to spoke sites, where they can arrange appointments with social workers, counselors, and community health teams. Spoke sites provide less intensive treatment and more limited services. They also provide integrated MOUD treatment and care, such as in the office-based opioid treatment (OBOT) model. While often patients transition from hub sites to spoke sites during the course of treatment, patients can also move from spokes to hubs as treatment needs change.

Examples of Rural Hub and Spoke Programs

  • The Vermont Hub and Spoke Model of Care for Opioid Use Disorder uses OTP regional addiction treatment providers as hubs, to offer patients intensive treatment as well as training to spoke providers. The spokes are all OBOT settings where continued medication prescription and recovery counseling can occur more locally, improving access for rural communities. The Vermont Blueprint for Health provides information on the model, including a Spoke Implementation Guide, to help others develop similar approaches.
  • The Washington State Hub and Spoke Project currently has eleven hubs across the state of Washington with spokes including jails, drug courts, and police departments. This model varies from other hub and spoke models because the hubs are not solely addiction treatment providers but rather can be primary care providers with MOUD expertise, expanding the reach and accessibility of the provider network.
  • The Doorway, in New Hampshire, is an online example of a hub and spoke model. This online platform connects patients with opioid use disorder (OUD) screening, treatment, prevention, and supports for long-term recovery in nine regions across New Hampshire.
  • The Colorado Opioid Synergy – Larimer and Weld (CO-SLAW) Project collaborates across seven OUD treatment sites to “increase the availability of buprenorphine dosing in hospitals, emergency departments, and jails.” The program's hub treatment center is located in a primary care setting in a rural area.

Implementation Considerations

The hub and spoke model is well suited for implementation in rural communities that may not have access to substance use disorder expertise and comprehensive support services locally. In rural communities where buprenorphine waivered providers are limited and methadone OTPs are scarce, the hub and spoke model is increasing in popularity.

Communities looking to implement a hub and spoke model for MOUD may consider developing a coalition to bring together providers with MOUD expertise as well as community health centers and support services across the state. Implementing a learning collaborative can engage MOUD providers in sharing best practices across the hub and spoke network.

Program Clearinghouse Examples

Resources to Learn More

Medication Assisted Treatment Program for Opioid Addiction
Provides information on the development and implementation of the Vermont Hub and Spoke model which expands treatment capacity and provides coordinated care to provide medication and treatment to people with OUD.
Organization(s): The Association of State and Territorial Health Officials (ASTHO), de Beaumont Foundation

Vermont Hub-and-Spoke Model of Care For Opioid Use Disorder: Development, Implementation, and Impact
Discusses the development, application, and effectiveness of a hub-and-spoke system of care developed by addiction medicine physicians and public health officials to expand opioid use disorder (OUD) treatment due the continuous shortage of office-based opioid treatment (OBOT) providers in the rural state of Vermont.
Author(s): Brooklyn, J.R. & Sigmon, S.C.
Citation: Journal of Addiction Medicine, 11(4), 286-292
Date: 2017