The hub and spoke model in healthcare connects a large central care center called the “hub” to smaller clinics or hospitals nearby called “spokes.” The hub has many specialists and advanced tools. The spokes provide regular care and help patients get specialist advice through telemedicine or visits from traveling doctors.
This model mixes in-person visits by specialists and virtual connections, like video calls and electronic referrals. It helps patients travel less and get better specialty care in rural areas.
For example, Munson Healthcare in northern Michigan uses this system for cancer care. Their Cowell Family Cancer Center is the hub. Five small hospitals and two outpatient centers are the spokes. They offer chemotherapy, infusion, cancer survivor care, and cancer doctor visits. Specialists often travel to these locations. Meanwhile, advanced practice providers (APPs) handle daily care and patient coordination at the spokes.
Rural patients often travel very far for specialist care. Some drive over 50 miles one way. In places like Montana, some must travel more than 400 miles just for short visits with subspecialists. These trips take time off work and cost money. This can stop patients from going to appointments on time.
The hub and spoke model brings care closer by letting patients get specialist advice and follow-ups at nearby spoke clinics. Telemedicine reduces the need to travel while keeping care quality high. This is very important for diseases like cancer and other long-term illnesses that need many visits.
Patients can avoid going to faraway hospitals since care is offered locally at spoke sites. For example, Munson Healthcare says patient satisfaction improved by four percent after starting their hub and spoke cancer care system. Patients can get same-day visits with APPs and specialists in person or through telehealth. This helps make care smoother and patients feel better about it.
There are fewer doctors in rural areas. There are about 13.1 physicians per 10,000 people in rural parts versus 31.2 in cities. The gap is even larger for specialists, with 30 specialists per 100,000 people in rural areas compared to 263 in cities. The hub and spoke model helps fix this by having specialists work through telemedicine and letting APPs handle daily patient care at spoke sites. At Munson Healthcare, specialists supervise APPs who manage routine care. This system helps make care more available and efficient.
For example, the University of Arkansas IDHI High Risk Pregnancy Program uses telemedicine to connect rural pregnant women to special prenatal care. They also offer 24-hour nurse help and e-consultations. In New Mexico, a Mobile Screening Program uses telehealth to check miners for lung problems and link them to lung doctors without travel.
Advanced Practice Providers like nurse practitioners and physician assistants play a key role in rural spoke clinics. They do daily care tasks such as checking symptoms, treating sudden illnesses, teaching patients about treatments like chemotherapy, doing procedures like bone marrow biopsies, and managing care after cancer treatment.
At Munson Healthcare’s cancer care system, APPs provide help when oncologists visit less often, usually once a week. They lower emergency visits and delays in treatment by managing symptoms and talking with specialists at the hub. This approach lets specialists see more patients and keeps care smooth despite doctor shortages.
Two main telehealth methods help specialty care in this model:
These telehealth ways improve how doctors diagnose, treat, and watch patients in rural areas.
Artificial intelligence (AI) and automation are added more often to rural specialty care. They make work easier, reduce doctor stress, and help manage patients better. Here are some examples:
This technology listens during patient visits and writes notes automatically. It helps doctors spend less time on paperwork. At Sanford Health, it cut down note-taking time a lot. This lets doctors focus more on patients.
For rural clinics where doctor time is short, this reduces tiredness and can improve quality and safety of care.
AI helps patients with long-term diseases like diabetes by adjusting medicines in real time. At Sanford Health, AI helps type 1 diabetes patients manage insulin remotely. This keeps blood sugar steady without many doctor visits.
Remote devices using AI watch vital signs like blood pressure and breathing rates. They warn doctors early if help is needed. This lowers hospital stays and improves health in rural areas.
AI-powered phone helpers manage appointment bookings, reminders, and questions. They help clinics run smoothly, reduce missed appointments, and keep patients involved.
AI looks at lots of patient data to find those at high risk who need specialist care. It also helps coordinate care by flagging missed follow-ups or delays, making sure patients move well between hub and spoke sites.
AI automates tasks like checking patient insurance, verifying providers, and managing licenses. This helps telehealth run smoothly, especially when providers work in many locations with different rules.
Healthcare leaders managing rural clinics or hospitals should carefully plan for a hub and spoke model. Important points include:
The hub and spoke model with telehealth is a practical way to fix the shortage of rural specialist doctors and improve patient access. Using virtual visits, having APPs provide local care, and adding AI tools improves work flow and patient support. Rural health systems can better meet patient needs this way.
Systems like Sanford Health and Munson Healthcare show better patient satisfaction, fewer delays in care, and more provider capacity. Rural healthcare leaders in the U.S. should learn about this model and invest in technology and staff to bring better specialty care closer to rural communities.
Sanford Health is America’s largest rural health system, serving populations across a wide geographic area, including North Dakota and Montana, with various healthcare facilities that range from large hospitals to critical access hospitals.
Patients in rural areas often have to travel hundreds of miles to see specialists, which can be burdensome due to time, costs, and potential delays in receiving care, especially for routine appointments.
Telemedicine allows patients to receive care remotely, minimizing the need for long travel distances. It provides access to specialists while enabling follow-up care to occur more conveniently.
Innovative virtual care models are designed to meet patient needs effectively by reducing the logistical challenges of accessing care, especially for those living in remote areas.
AI algorithms in diabetes management help regulate insulin delivery, significantly improving patient outcomes by reducing their daily burden and allowing for more normal lifestyles.
Ambient listening technology reduces documentation time for healthcare providers, allowing them to focus more on patient care and enhancing work-life balance by decreasing administrative burdens.
The hub and spoke model connects rural hospitals (spokes) with larger healthcare facilities (hubs), facilitating easier access to specialty care without transferring patients unnecessarily.
By using virtual care technologies, Sanford Health enables specialists to consult with patients in rural hospitals, keeping them closer to home and minimizing the need for transfers.
Patient feedback guides the development of services and technologies, ensuring that the solutions implemented truly address the needs and preferences of the populations they serve.
Experts believe AI will serve as an essential tool in healthcare, enhancing but not replacing physician roles and improving the quality and efficiency of care delivered to patients.
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