Lebanon
The Upper Valley center is part of a network of nine regional hubs that New Hampshire’s Executive Council approved on Wednesday, using $16.6 million in federal funds to be spent over two years.
Included in the council’s approval is about $1.54 million for the center that will be operated by Dartmouth-Hitchcock in the Rivermill Complex in Lebanon, where the hospital system currently offers addiction treatment, including its Moms in Recovery program.
“It fits perfectly into our mission,” Dr. Sally Kraft, D-H’s vice president of population health, said in a phone interview on Friday.
The statewide effort to create a hub-and-spoke system will expand on efforts the Lebanon-based hospital system already is making to build a comprehensive addiction treatment system, Kraft said.
“What really this is going to do is make it easy for patients to know where to go for help,” she said. “Of all the things that we can do, that’s almost No. 1.”
The state’s hubs are intended to be points of entry to connect people seeking treatment with the “spokes” providing the services they need, Katja Fox, director of New Hampshire’s Division for Behavioral Health, said in a phone interview last month.
Beginning on Jan. 1 — unless an alternative timeframe is approved by the Department of Health and Human Services — the hubs will provide referrals to addiction treatment, recovery support services, as well as other relevant health and social services, according to the agreements approved by the Executive Council last week.
The hub funds come out of a $45.8 million grant from the federal Substance Abuse and Mental Health Services Administration that was announced in September. The grant, which will be paid over two years, offers an opportunity for the state to examine how it serves people struggling with opioid addiction, with the aim of making it easier for individuals and families to access services, Fox said.
Fox was enthusiastic about the difference the federal funds will have on the opioid epidemic in New Hampshire, which left 488 people dead from drug overdoses last year.
The state aims to reduce the number of overdose deaths by 10 to 15 percent by 2020, the end of the grant period, according to its grant application.
“It’s really exciting,” Fox said. “It’s a great opportunity for all of us.”
While Lebanon’s will be the only hub in the Upper Valley, two other hubs will be in western New Hampshire. One will be operated by D-H affiliate Cheshire Medical Center in Keene and another will be operated by Littleton Regional Hospital in Littleton.
Both D-H and Cheshire have been involved in a Medicaid waiver program known as the Delivery System Reform Incentive Program that is focused on changing the way care is provided to patients struggling with addiction and mental illness, Kraft said.
This is “another opportunity to expand our capacity to care for patients,” she said.
New Hampshire’s other hubs will be at Androscoggin Valley Hospital in Berlin, Concord Hospital, Wentworth-Douglass Hospital in Dover, LRGHealthcare in Laconia, and Granite Pathways will operate two, one in Manchester and another in Nashua. The last two will be structured so as to preserve the “safe station model” that invites those struggling with addiction to come to the cities’ fire stations to be connected to treatment.
At a minimum, the hubs will offer face-to-face and telephone services Monday through Friday from 8 a.m. to 5 p.m., according to the state’s contract with D-H. They will screen patients to determine their need for services, help those in crisis to access emergency services, offer relevant clinical evaluations and develop service plans based on those evaluations.
The plans will include ways to address patients’ needs, including those related to physical health, mental health, peer support, social services and criminal justice.
The hubs will work together to ensure telephone access, reached by calling 211, to a clinician for overnight and weekend hours.
The hubs are responsible for case coordination for patients and for maintaining regular contact with patients while they are enrolled in care at the “spokes,” which Fox said are treatment providers that the hubs will refer patients to.
In addition, the hubs’ operators are required to work together to create a centralized referral database of substance use disorder and mental health treatment providers to include real-time availability of services to ensure “rapid placement” into appropriate levels of care for patients. A plan for creating this database is set to be in place by July 1, 2019.
Fox said she is looking forward to having more information about the availability and use of treatment services.
“It is imperative that we know what’s working and what isn’t,” she said.
The hub operators also will evaluate the feasibility of beginning medication-assisted treatment in emergency rooms, operating outpatient and inpatient treatment services and coordinating overnight placement for hub patients who need a safe place to stay while awaiting treatment.
A report of the findings of this evaluation is set to be developed by July.
The hubs also will distribute the overdose reversal drug naloxone as well as relevant information and will create a fund to help patients cover costs such as housing, transportation, child care and medication co-pays that aren’t covered in another way.
D-H plans to employ at least 10 people to do all of the work of the Lebanon hub, including a master licensed alcohol and drug counselor or a licensed independent clinical social worker; a clinical secretary, recovery coach, resource specialist, program manager, implementation specialist, data and research coordinator; a medical director; a medical assistant or licensed nursing assistant; and a physician to provide medication-assisted treatment.
These positions will be funded, at least in part, by the state contract and the federal grant.
Though the next two years of the program are federally supported, the long-term future of New Hampshire’s hub and spoke system is not secure.
The cover letter of the packet provided to the Executive Council said, “In the event that the Federal Funds become no longer available, General Funds will not be requested to support this program.”
Though this is only the beginning of the hub-and-spoke model, Kraft said she and others are already looking to the future and aiming for sustainability. She said she’s hopeful that state officials will continue to advocate for federal funding, and she said hospitals will have to work with all their payers to garner support for successful ways of delivering care.
“I don’t think anybody believes that we’ll have eradicated substance abuse before (the grant ends),” Kraft said.
The funds also have some restrictions and cannot be used to treat addictions to other substances, Fox said.
“This is all for opioid-use disorder,” she said.
Still, Kraft said, the systems and knowledge that providers develop to care for people with opioid addictions will be applicable to patients with other needs.
“We’re not creating a hub and spoke for tobacco nor alcohol use disorders,” Kraft said. But providers will be “learning a lot about how to activate a system of care beyond our walls for anyone.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
