New Medicaid Benefit: Hub and Spoke Substance Use Disorder Health Home Pilot

Announcing Substance Use Disorder Health Home Hub Request for Applications 

The Wisconsin Department of Health Services (DHS) has closed its application process for the collaborative planning and development of Health Homes for Substance Use Disorder (SUD) Treatment with a hub and spoke model. Applicants chosen for the pilot will be announced in Fall 2020.

Health Home hubs will work with people who present with high intensity treatment needs and be able to provide all six of the required core services identified below. Hubs will work with spokes to provide lower intensity treatment needs and build capacity at the spoke level. People enrolled may move from hubs to spokes or from spokes to hubs as their person-centered treatment needs change.

The health home hub and spoke model will promote seamless transitions of care from hospitals, emergency rooms, county crisis and other human service programs, jails or correctional facilities, or other sites where treatment might be initiated to specialized Health Homes. The Health Homes will offer evidence-based treatment and promote the continuity of care to meet the needs of people with severe or complex SUDs and other co-occurring conditions. This will occur by ensuring timely and proper follow-up services to ease the transition to long-term recovery services and supports.

The target population will include Medicaid-eligible youth and adults who have severe SUDs and are experiencing or are at a high risk for chronic physical and mental health conditions.

 

Introduction to “Hub and Spoke” Health Home Pilot Stakeholder Concept Development Meeting Held June 10, 2020

As part of Wisconsin’s continued comprehensive approach to improve access to quality SUD care, DHS outlined details of a new health home benefit for Medicaid members. DHS wanted this effort to be a collaborative process, so we reached out to key stakeholders who work closely with people diagnosed with an SUD to ask for their feedback.

At this meeting, DHS shared a draft of our framework and benefit design with key stakeholders who shared their common interest in finding better ways to provide services and increase the quality of care provided. DHS sought their input and recommendations on our design concepts so that the final version of the benefit would be feasible for providers and effective for Medicaid members affected by SUDs to achieve better outcomes. DHS will continue to collaborate with the initial pilot sites during the implementation of the pilot program.  

Concept meeting documents: Concept paper, clinical workflow, meeting presentation

 

Commission on Substance Abuse Treatment Delivery 2018 Report

The Commission on Substance Abuse Treatment Delivery was created to research hub and spoke delivery models (including California, Rhode Island, Vermont, and Washington) for opioid treatment, recommend adoption of a hub and spoke model for Wisconsin, and identify key implementation considerations. The Commission determined that the Vermont hub and spoke model was instrumental in increasing treatment capacity for opioid use disorder to the highest rate in the U.S.  

Some gaps in the Wisconsin SUD treatment system remain, including limited access to specialty SUD treatment in rural areas of the state, silos separating SUD treatment providers and other health care professionals, and inconsistent patient engagement through the entire continuum of SUD care including early identification and initiation, treatment, and long-term recovery supports. To address these gaps, the Commission proposes a clinical model for Wisconsin that details expectations for the SUD treatment system across the continuum from initiation of treatment to recovery.

This pilot project was designed to positively impact Wisconsin citizens with SUDs.

 


Wisconsin Medicaid plans to pilot a hub and spoke health home benefit in up to three pilot sites around the state for members with severe SUD.

 

Hub and spoke diagram

 


 

In January 2018, Executive Order #274 created the Commission on Substance Abuse Treatment Delivery to research hub and spoke delivery models.
Their final report recommended creation of a new treatment model, based on Vermont’s hub and spoke approach.

 

 
Last Revised: September 22, 2020