Care is coordinated and seamless across the care settings and people are moved appropriately and timely Download Data

Number of Medicaid Beneficiaries Treated by Spoke Providers in Chittenden County

645September 2018

Story Behind the Curve

In an ASPE Issue Brief in early 2015, the U.S. Department of Health and Human Services defined expansion of Medication-assisted Treatment (MAT) as one of three target priority areas to combat opioid abuse in the United States. Since 2013, Vermont has employed a system known as the Hub and Spoke Model to deliver MAT services to those suffering from opioid substance abuse disorder. The hubs are seven Opioid Treatment Program (OTP) facilities, serving five regions across Vermont. Each hub is designed to treat clients with the highest needs, as well as those receiving methadone maintenance. Additionally, any service provider who is wavered to prescribe MAT medications in an Office Based Opioid Treatment Program (OBOT) would be considered a spoke provider. In December 2016 there were roughly 180 spoke prescribes in Vermont. Some of the larger spoke providers in Chittenden County include the Community Health Center of Burlington (CHCB), UVM Addiction Treatment Partners (ATP, formerly the DayOne program), and Comprehensive Obstetrics and Gynecological Services (COGS) at the UVM Medical Center.

Between December 2016 and January 2017, spoke treatment levels for Medicaid patients increased by 16%, the largest recorded increase since 2013. Since January 2017, however, spoke treatment levels have fallen to just under 600 patients, but still remain well above the average treatment level of 472. Though it is difficult to ascribe causality to any single factor, or even a number of factors, one key element to the rapid increase in treatment may be the expansion of spoke providers in Chittenden county in 2016, and one element of the decline may be the closing of Maple Leaf Treatment Center between January and February 2017. In an attempt to help alleviate the capacity bottleneck at the Howard Center Chittenden Clinic, also known as the Northwest Hub, there have been concerted efforts to increase spoke treatment capacity. As a result, spoke prescriber numbers in Chittenden County have increased from 38 to 70 between March and December 2016, an 84% increase. The increased number of prescribers may have allowed hub providers to transfer more patients to spoke levels of care within the county. Conversely, when Maple Leaf Treatment Center closed, roughly half of the patients receiving treatment there continued their treatment in Chittenden County, while the other half have received treatment from providers in neighboring counties, and may therefore no longer be reflected in Chittenden County figures.

For more information about treatment levels across Vermont, in hub and spoke settings, please refer to this Opioid Use Disorder Treatment Census and Wait List report produced by the Vermont Department of Health.

Citation

This information was collected by the Blueprint for Health within the Department of Vermont Health Access (DVHA). A census of Vermont MAT hubs and spokes is performed at regular intervals, and a report is produced by the Division of Alcohol and Drug Abuse Treatment Programs (ADAP) within the Vermont Department of Health, but may only provide a three month average of Medicaid patients receiving spoke treatment, reported on a quarterly basis. Values reported here that predates December 2016 are three month average values, as reported by DVHA. Spoke prescribes include any Primary Care Physician (PCP), Substance Treatment Professional, Nurse Practitioner or Physicians Assistant that have been granted a waiver to prescribe MAT medication. It should be noted that though roughly 27% of Vermonters receive some kind of Medicaid benefits, it is thought that Medicaid recipients account for nearly 70% of those receiving MAT treatment statewide, and so while these figures should not be considered the total number of individuals receiving spoke treatment, they can be considered an accurate approximation in treatment levels when shifts in trend occur. For more information on Medicaid enrollment rates, please refer to this interactive data set provided by the Kaiser Family Foundation on Total Monthly Medicaid and CHIP Enrollment.

Last Updated: October 2017

Strategy

By supporting Alliance partners through data analysis, the CCOA aims to provide information to help service providers make informed decisions. One way the CCOA hopes to achieve this is by helping the Chittenden County Triage Team, a part of the Opiate Care Alliance of Chittenden County (OCACC), track how different levels of need, identified by the Treatment Needs Questionnaire (TNQ), are correlated to successful treatment with different spoke providers. The goal would be to identify which spokes are most successful when treating patients with certain levels of need, and then to incorporate this information into the triage process.

Additionally, the CCOA hopes to provide service providers with data and information to assist ongoing efforts to change how patients with Opioid Use Disorder (OUD) are perceived by prescribers. Efforts to increase the number of spoke providers have been largely successful, however there is still work to be done in order to increase the number of patients that spoke prescribers are willing to take on. As noted in this Health Department FY '18 Budget Highlights report, 70 Spoke MDs were prescribing to 596 recipients in Chittenden County in December 2016, for a rate of 8.5 recipients per MD. In the same time period, the average statewide recipient to MD rate was 14.3, with some counties reporting rates as high as 25.5. By tapping prescribers from counties that are already experiencing high rates of treatment for their perspective, the CCOA may be able to help remove some of the stigma around treating OUD patients.

Scorecard Result Program Indicator Performance Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy