Additional Considerations
NC Medicaid should consider requiring PHPs to develop transition care that address one of the four APHON/ASPHO best practices at a time. This would allow for improved care in the shorter term, rather than requiring PHPs to develop a comprehensive transition plan that addresses all best practices at once. Transition services should cover Medicaid enrollees with SCD up to age 21 and, to the extent possible, include work to ensure that patients can seamlessly transition into new insurance plans that cover the desired adult provider. Coordination with the North Carolina Division of Public Health (DPH) Sickle Cell Syndrome Program would help ensure that individuals aging out of Medicaid can continue receiving appropriate care.171 This is a medium-term investment, because PHPs need time to develop transition programs for both urban and rural care. For urban areas, PHPs can emulate the St. Jude and VCU-TIP models. For rural areas, comprehensive sickle cell centers and pediatric providers can provide telementoring services for local adult providers. Telementoring allows pediatric providers to inform adult providers about new patients, address preconceptions, and build mutual trust to facilitate communication about how to best serve patients.172 Hub and spoke models, as detailed in Part I, benefit young adults in particular and therefore would be ideal to facilitate well-coordinated transitions into adult care in rural North Carolina. NC Medicaid should also consider reimbursement for transition coordination activities and require coordination specifically for SCD care.173 Adjustment of PHP contracts to cover coordination is a short-term investment because it can be done unilaterally by NC Medicaid.
1.2 Primary and Specialty Care Coordination NC Medicaid should invest in the development of a network of primary care providers (PCPs) knowledgeable about the treatment of SCD and should implement additional financial incentives for care coordination between PCPs and SCD experts. Implementation: • NC Medicaid should identify PCPs already providing care to several patients with SCD. • NC Medicaid, the PHPs, and the state’s sickle cell centers should invest in these PCPs’ knowledge of SCD through means such as telementoring. • NC Medicaid should encourage PHPs should make their members with SCD aware of these PCPs. • NC Medicaid should convene a working group to explore additional financial incentives NC Medicaid can implement to encourage primary and specialty care coordination for individuals with SCD. Background
Every individual living with sickle cell disease should see both an SCD specialist and a primary care provider. However, the need to see multiple providers can burden individuals with SCD, and this burden can be made heavier if the PCP is uncomfortable providing basic care to someone with SCD or if there is poor coordination among the PCP and SCD specialist. According to one provider interviewed, because of PCPs’ lack of knowledge and the burden of visiting multiple providers, individuals living with SCD often rely on their SCD specialist to fill the role of a PCP. Hematologists, however, are not equipped to fill this role.
Part II. Sickle Cell Disease Recommendations 41
