Examples: Telehealth Other states have found success in expanding telehealth services specifically for their SCD patients. During the COVID-19 pandemic, Boston Medical Center used video and phone communications to assess the needs of people with SCD and prevent lapses in care.217 Patients’ responses to the use of these remote communications were overwhelmingly positive and no-show rates dropped significantly. The Medical College of Georgia (MCG) Sickle Cell Center established three telemedicine clinic sites in rural areas throughout the state of Georgia to meet the clinical needs of patients with SCD and reduce no-show appointments.218 This resulted in an increase from 1,143 to 1,889 encounters per year, including an increase from 271 to 745 rural encounters, with the addition of just one physician assistant. The University of Alabama at Birmingham School of Medicine conducted a retroactive review of hydroxyurea laboratory and clinical outcomes and found that establishing satellite sites and implementing telehealth was just as effective in treating SCD patients with hydroxyurea as traditional in-person treatment.219 In the short term, requiring PHPs to cover telehealth services would set a floor for behavioral and psychological health services covered by Medicaid throughout the state. In the medium- to long-term, NC Medicaid should consider supporting telehealth clinic sites in rural areas, potentially through a hub and spoke model—as outlined in Part I—and reimbursing hospital outpatient and physician services at parity.
46 Part II. Sickle Cell Disease Recommendations
2.2 Sickle Cell Day Hospitals NC DHHS should bolster established SCD day hospitals in North Carolina. Implementation: • NC DHHS should support legislation approving increased funding through state grants for established SCD day hospitals in North Carolina. Background
Vaso-occlusive crises (VOCs)—the most common cause of acute morbidity in SCD— lead to episodes of intense pain and are the defining feature of SCD.200 These pain crises are unpredictable, start suddenly, and are poorly treated, leading to much of the current care for VOCs to occur through emergency department (ED) visits and hospitalizations.201 Entering the ED is often a last resort for patients.202 Patients report, “feeling intense anxiety and stress about going to the hospital, sometimes delaying or avoiding seeking necessary care.”203 When experiencing VOCs, individuals with SCD are left with limited options. They often end up an ED—the last place they want to be—where they are “too often…treated with stereotypical idealism and inherent bias that ultimately leads to them avoiding going for help or simply not receiving it in their greatest time of need.”204 Individuals with SCD repeatedly report suboptimal care in EDs.205 Non-SCD specialist providers often hold the misperception that SCD is simply a pain condition, an oversimplification that can lead to inappropriate care (e.g., lacking treatment with fluids, oxygen, and other medicines). Too often ED providers have negative attitudes and perceptions of SCD patients. ED providers frequently label individuals with SCD as “drug seeking” or “Sickler,” a derogatory term steeped in the historic and racist disregard for the SCD
