Inside the VA’s Hub-and-Spoke Model for Multiple Sclerosis Care: Rebecca Spain, MD

The Department of Veterans Affairs (VA) Multiple Sclerosis Centers of Excellence operate as a nationwide hub-and-spoke network designed to ensure that every veteran with multiple sclerosis (MS) has access to specialized, multidisciplinary care wherever they live. In this interview, Rebecca Spain, MD, MSPH, FAAN, associate professor of neurology at Oregon Health & Science University, and codirector of MS Center of Excellence–West at the Portland Veterans Affairs Medical Center, discusses how the Centers collaborate across regions to deliver state-of-the-art treatment through telehealth and local partnerships, while also leveraging the VA’s vast electronic health records and biorepositories to advance MS research, including landmark findings linking Epstein-Barr virus to the disease’s origins.

This discussion followed Spain's session “Management of Patients with Multiple Sclerosis" at the Institute for Value-Based Medicine event hosted by The American Journal of Managed Care^® in Portland, Oregon, on October 21, 2025.

This transcript has been lightly edited; captions were auto-generated.

Transcript

How do the VA Multiple Sclerosis Centers of Excellence work together to better understand MS?

Well, I love working with the VA MS centers of excellence. It's an incredible national organization that works in a hub-and-spoke model, where there are regional specialty programs that have an MS expert and an MS multidisciplinary team of people that can deliver that multidisciplinary care, that interdisciplinary care, that optimizes veterans’ health and function. So it's—like I said—a hub-and-spoke network, where currently we have 35 of these regional specialty programs, and then they liaison with smaller facilities in their geographical area to provide remote care via telehealth, which the VA does really well, and to provide consultation to the local providers to make sure that every veteran—wherever they are geographically—has access to state-of-the-art MS specialty care. That's one way we deliver the care.

Since it's the largest health care organization in the United States, and there are over 20,000 veterans with MS that hit the system each year, it's actually an incredible opportunity to do epidemiological research, and that's another arm of what the MS centers of excellence do; we investigate what are exposures that might put some veteran at risk for MS. What are long-term outcomes? We can use this unified electronic health record database to really understand risks and outcomes in a large population of people with MS. In fact, recently, some great data came out of the VA linking Epstein-Barr Virus to MS etiology. And that was possible because of the biorepository that the VA and the Department of Defense keep on veterans and the database to follow those people subsequently.

Watch the first portion of Spain's interview here.