By Jonathan Jaffrey, Sr. VP and Chief Population Health Officer. University of Wisconsin Health
Vermont has made impressive strides in addressing the opioid addiction crisis by increasing the number of medical providers who offer medication assisted treatment (MAT) to patients. As a result of the Hub-and-Spoke model of addiction treatment, including reimbursement through Medicaid, Vermont now has the highest capacity for treating opioid use disorder of any state in the country.
During our trip we visited:
- Vermont Department of Health
- Hub practice at Howard Center Chittenden Clinic
- Spoke practice at Community Health Centers of Burlington
- Addiction Treatment Program at University of Vermont Medical Center
While it’s hard to summarize all that we learned during this visit, here are a few of our observations:
Treating opioid addiction requires a culture shift
Primary care providers in Vermont have embraced the concept of treating addiction like any other chronic condition. In many of the primary care practices, all or most of the providers are waivered to offer medication assisted treatment (MAT). This enables them to care for the patients needing MAT who are already part of their practices and panels. Further making the case that treating opioid use disorder is part of primary care, all family medicine and internal medicine residents at UVM are trained on prescribing MAT as part of their residency training.
A team-based approach is critical
Primary care and other Spoke providers are able to treat patients with opioid use disorder because there is a team-based approach to care. Each Spoke has a MAT Team that includes a registered nurse and licensed behavioral health provider in addition to a prescribing physician. Together they are able to meet the needs of patients, including identifying resources for social support services.
The Hubs create a safety net for Spoke providers
Hub practices handle assessment, start treatment, triage best location for ongoing treatment and support the most complex patients including following relapse. Because of the ability for Spoke providers to refer patients back to Hubs if needed, they are more willing to prescribe MAT. Physician champions like Dr. John Brooklyn at the Howard Center ensure that patients at Hubs have access to all forms of MAT along with counseling, mental health services, health screenings and trauma-informed care.
This is a process of continuous learning
It is important for providers and staff to have space to discuss complex cases and engage in ongoing education and professional development. Dr. Sanchit Maruti is leading important work at the UVM Addiction Treatment Program to facilitate learning amongst providers across the state through a learning collaborative that meets monthly using videoconference technology.
We are grateful to our hosts for all that they shared during our visit!
Jonathan Jaffery, MD, Chief Population Officer, UW Health
Michael Heifetz, Medicaid Director, Administrator of Division of Health Care Access and Accountability, WI Department of Health Services (former)
Jenny Malcore, Assistant Deputy Secretary, WI Department of Health Services
Todd Campbell, Adult Community Services Administrator, Dane County Department of Human Services
Cheryl Wittke, Executive Director, Safe Communities of Madison and Dane County
Aleksandra Zgierska, Family Medicine and Addiction Medicine, UW Health
Mike Rountree, Addiction Medicine Fellow, UW Health
Robin Lankton, Program Director, Community Health Improvement, UW Health