HUB 101: Understanding a Community HUB

As announced earlier this year, Governor John Kasich's Office of Health Transformation will invest $350,000 to create a Community HUB focusing on high-risk expectant mothers in Southeast Ohio through a partnership with IPAC and Nationwide Children’s Hospital’s Partners for Kids (PFK). IPAC members, including Executive Director Dawn Mollica and Dr. Jane Hamel-Lambert, are playing an instrumental role in the HUB’s creation.

As the IPAC team works to get our Community HUB off the ground, we wanted to take a step back for a moment. In this article, we describe the basics of the HUB model. Much of this information and more can be found in The Quick Start Guide to Developing Community Care Coordination Pathways, published by the Agency for Healthcare Research and Quality (AHRQ).

What is a Community HUB?

The United States spends significantly more money per capita on health care services than any other nation in the world. But we lag behind most other developed countries in terms of key outcome measures, including infant mortality, health equity, patient perceptions of safety, efficiency and effectiveness. Much of the gap between spending and outcomes stems from the American health care system’s difficulty identifying at-risk individuals and providing them with effective, coordinated medical and social services.

The Community HUB serves as a framework that can bridge the gap. The HUB model involves working across organizational silos within a community to reach at-risk individuals and connect them to health and social services that yield positive health outcomes.

How does it work?

Rather than allow providers of health and social services to continue functioning in isolated silos, the Community HUB requires them to work collaboratively, reaching out to those at greatest risk and connecting them to evidence-based interventions, with a focus on prevention and early treatment. Through communication, collaboration and built-in incentives, the HUB increases the efficiency and effectiveness of care coordination services.

To ensure quality and accountability across all providers of care coordination services, the HUB acts as a central clearinghouse that “registers” and tracks at-risk individuals, making sure that their biological, psychological and social needs are met.

Do other HUBs exist?

There are currently 16 Community HUBs established throughout the United States. The model was developed by the Community Health Access Project (CHAP) in Mansfield, Ohio, under the leadership of Drs. Sarah and Mark Redding.

What’s wrong with the current model?

The current business model for the provision of care coordination services to at-risk populations remains inadequate. Care coordination contracts typically purchase “work products” that have no meaning or clear positive impact on the clients being served. Contracts typically do not require those who provide care coordination to ensure that individuals actually get connected to or benefit from needed services. Rather, payments are based on the volume of work products provided, such as the number of individuals added to a case list, visits or phone calls made or notes charted. In addition, the current payment structure creates no incentive for the multiple organizations providing services to communicate or collaborate with each other, thus leading to duplication and other inefficiencies.

The Community HUB can help improve the payment system by fundamentally changing the way care coordination contracts are written. Payments are revamped to recognize the time, resources, cultural competence and skill required to achieve measurable and meaningful results. A pay-for-performance methodology provides financial incentives to providers that are tied to improving outcomes, and it eliminates duplication among health and human service agencies. This type of system can also help the United States close the health care cost and quality gap with other developed nations.

What does this mean for Southeast Ohio?

In Mansfield, the Community Health Access Project achieved a 30 percent reduction in the risk for low-weight births using this model. We hope to have similar results with our Community HUB based in Southeast Ohio. Look for more details on our Community HUB in the next installment of this series.