CA Hub and Spoke System:
MAT Expansion Project


Project Information


Project Description

On April 21, 2017, the Department of Health and Human Services (HHS) announced $485 million in 21st Century Cures Act-authorized funding for 50 states, the District of Columbia, and four territories to address opioid abuse. The amount allocated to California is $44,749,771 for the first year of the State Targeted Response (STR) to the Opioid Crisis Grant program administered by the Substance Abuse and Mental Health Services Administration (SAMHSA).

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California's project is named "Medication Assisted Treatment (MAT) Expansion." The grant focuses on two projects: The California Hub and Spoke System (CA H&SS) and the Tribal MAT Project.  Within a two year grant period, the MAT Expansion Program is projected to serve over 20,000 individuals with Opioid Use Disorders (OUD) to address the opioid crisis in California.

The project design is an adaptation of the successful model used in Vermont, called the Hub and Spoke Model.  Each awarded region will have a specialized addiction center of expertise, known as the Hub, that is an opioid treatment program (OTP).  Each Hub is connected to a number of Spokes, which is any office or clinic with a buprenorphine prescriber.  Spokes will have access to a dedicated MAT team, consisting of one registered nurse and one licensed clinical social worker for every one hundred patients on buprenorphine under Medicaid. Spokes have the ability to refer complex patients to the Hub in their region for stabilization. MAT teams are essential to the success and effectiveness of Spokes.

With implementation support through regionalized Learning Collaboratives and ongoing training and mentorship opportunities, The California Hub and Spoke System (CA H&SS) aims to deal with the opioid crisis in California through a collaborative effort of relevant stakeholders.

There are currently 19 funded Hubs in the state of California.  The project will begin with approximately 119 spokes across the state.

The PRIMARY goals are to prevent overdose and treat OUD as a chronic disease
Additional goals include: (click for more and be able to hide again)

  1. Implement the California Hub and Spoke System (CA H&SS) in various areas throughout California.
    • Improve access to MAT services in at least 30% of counties with the top ten highest overdose rates.
    • Expand access to integrated MAT services in urban areas.
    • Increase the access to NTP and/or MUs in underserved areas by three clinics.
  2. Increase the availability and utilization of buprenorphine statewide.
    • In coordination with other statewide efforts, increase the total number of physicians and NPs waivered to prescribe buprenorphine.
    • Increase the statewide average of the number of opioid users served by each waivered physician/NP.
    • Increase the availability of counseling services for buprenorphine patients and a variety of support services for MDs in primary care settings.
  3. Improve MAT access for tribal communities (Tribal MAT Project).
    • Increase the total number of tribal waivered prescribers certified,
    • Provide expanded MAT services that include tribal values, culture and treatments.

For questions regarding the Opioid STR Grant, please email: DHCSMATExpansion@dhcs.ca.gov

To contact UCLA for training, technical assistance and evaluation activities, please email Valerie Antonini at vjpearce@ucla.edu

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What is a Hub?

A Hub is a Narcotics Treatment Program (NTP) that specializes in treating patients with OUD. They have flexibility, within the state guidelines, to choose clinical service providers ("spokes") to build a treatment network that meets community needs.

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The program will improve access to MAT services, especially in counties with the highest overdose rates. The implementation of the CA H&SS will increase the total number of physicians, physician assistants and nurse practitioners prescribing buprenorphine, thereby increasing the availability of MAT for patients with opioid use disorders.

Chart describing hubs and spokes

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What is a Spoke?

Spokes can be an FQHC, mental health center, private practice or community clinic where a buprenorphine prescriber or potential prescriber is available. Spokes receive a variety of support services from the Hubs, including the ability to refer complex patients for stabilization and access to MAT Team, consisting of a nurse and behavioral health specialist to coordinate care.

The program will improve access to MAT services, especially in counties with the highest overdose rates. The implementation of the CA H&SS will increase the total number of physicians, physician assistants and nurse practitioners prescribing buprenorphine, thereby increasing the availability of MAT for patients with opioid use disorders.

 
 

Find a Hub and Spoke

Contra Costa Humboldt Los Angeles Chico Manteca Marin Marysville Redding Riverside Roseville Sacramento San Diego San Francisco Santa Cruz - North Santa Cruz - South Santa Rosa Solano

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The 19 Hubs are located all over the state of California. These Hubs have flexibility to choose their spokes and structure themselves how they want, as long as it abides with the state guidelines. In addition to providing MAT services to patients in their clinic, the Hubs can also provide an array of services varying from onsite urine testing, to transportation, to counseling. The Hubs have a responsibility to serve as referral centers for the Spokes in the region and provide consultation services as needed to their spokes.