Introduction It is estimated that there is 1 board certified Advanced Heart failure physician per 6500 heart failure patients in the country. Large academic centers with transplant programs have typically housed such advanced heart failure physicians. We show the benefit of a Hub and spoke model with incorporation of such a physician at the spoke as a potential solution to tackle the public health problem of heart failure. Methods Houston Methodist is a hospital system composed of a Houston Methodist Hospital medical center and six community hospitals serving the Greater Houston metropolitan area. While the hub hospital houses a large transplant and LVAD program with 7 advanced heart failure physicians, in 2017 we hired a practitioner to spend majority time at the Houston Methodist Baytown (HMB) location. We gathered referral patterns for advanced heart failure evaluations prior to and after this structure change. Results From 2015-2017, there were 13 referrals for advanced HF (AdHF) therapy consideration to the hub hospital from HMB cardiologists. Since 2017 to the first quarter of 2019 there have been a total of 60 referrals from practicing cardiologists for management of AdHF locally to the advanced heart failure physician leading to 17 patients being evaluated, 3 receiving LVAD implants, 1 transplant and 2 listed for transplant. A shared care model for advanced therapy has facilitated local care and currently 5 LVADs and 6 transplant patients are being followed at HMB. Conclusions The local presence of advanced heart failure practitioners in community hospitals facilitates care and appropriate referral to specialists. While criteria to recognize advanced heart failure patients is evolving, there seems to be a need for a specialized expertise to manage many of these complex heart failure patients in the community. Availability of such expertise locally might be the way to influence the management for heart failure patients in the broader scope of heart failure care in the community.