Vermont Governor Phil Scott and the state’s Secretary of Human Services were in Washington Tuesday to testify before the House Ways and Means Subcommittee on Health. Their focus was on the state’s “Hub and Spoke” treatment model that is getting more people into treatment for addiction.
The subcommittee hearing on “The Opioid Crisis: Removing Barriers to Prevent and Treat Opioid Abuse and Dependence in Medicare” was the second in a series being held on the crisis, according to chair Illinois Republican Peter Roskam. “We're talking about sons and daughters, brothers and sisters, mothers and fathers, those who are dear to us who are struggling with this in and around our communities. All of us represent constituencies that are being overwhelmed by this crisis and all of us are looking for solutions.”
Vermont Democratic Representative Peter Welch says while the federal government can help, the hard work is being done at the state level. “The hard work is done with first responders, with mayors, with governors. One distinguishing thing about Vermont is we embraced the challenge on a bipartisan basis. The Democratic governor predecessor to Phil Scott, Peter Shumlin, spoke in his entire address in 2014 about the opioid crisis. And I remember talking to some of my colleagues here saying ‘Peter why would you be advertising that bad news?’But then as we talked acknowledging that that was a devastating issue in their own communities. In Vermont now we have this bipartisan approach to trying to address the tragic circumstances of opioid addiction.”
Governor Phil Scott described the state’s four legs to address the issue: prevention, recovery, treatment and enforcement. He noted that to address the growing number of people seeking treatment Vermont implemented a “Hub & Spoke” system. “To treat opioid addiction Vermont operates a Medication Assisted Treatment, or MAT system called Hub & Spoke. Through well coordinated and comprehensive services we treat opioid addiction like we do any other chronic condition. Our hubs provide all FDA approved medications. They also provide critical nursing, counseling and care management. In our spokes primary care offices prescribing Buprenorphine are supported by nurses and counselors who offer more complete care. Finally coordination between hubs and spokes assures the patients receive the appropriate level of care as they need it.”
Alabama Democrat Terri Sewell questioned the governor regarding how Vermont’s model works to emphasize employment opportunities, provide access to transportation, and increase Medicare coverage. “That's what the beauty is of this Hub & Spoke model that we can have treatment facilities closer to those who need it and when we see an area such as we did that needed more treatment we set up another hub. So it's essential that we react every time that we see an issue. Stigma is an important part of reintegrated those into the workforce and I think we've made some positive gains in that respect.”
Vermont Secretary of Human Services Al Gobeille told Nebraska Republican Adrian Smith that the type of management and monitoring being used by the state is possible under the Medicare program. “The letter that we sent to the H.H.S. secretary was basically a request not that Medicare just simply treat this like a chronic illness and begin to pay for the delivery of services, counseling or medically assisted treatment for example but to actually participate in Vermont’s system of care which is partially Hub & Spoke but also other treatment modalities. So it's not enough to just sort-of pay the bill it's about the way in which the services are delivered and organized that we want Medicare to fully participate in like other payers.”
According to the Vermont Health Department, more than 6,000 people are participating in the Vermont Hub & Spoke treatment program. Nine regional hubs provide intensive treatment for addiction. Ongoing treatment integrated into general medical care is then provided at 75 local spokes within communities. The Hub & Spoke Services are paid through Medicaid.