anywhere, including in EDs. In a separate interview, the state’s Sickle Cell Educator Counselors confirmed that many of the state’s SCD centers produce provider-signed pain management plans for their patients to present in the ED. Additional Considerations
The addition of “people with sickle cell disease” to the list of priority populations will task PHPs to collaborate with providers to bring resources to SCD and reverse the neglect the disease has historically received. This will ensure that people with SCD who have complex care needs will consistently receive care management and individualized care plans that improve their health outcomes, regardless of the PHP they are enrolled in. The state’s PHP contract already requires care management and individualized care plans for other complex populations and acknowledges that “people with sickle cell disease” could be a priority population as determined by PHPs, so creating a standalone designation of “people with sickle cell disease” as a priority population is a change that can be achieved in the short-term. It is unclear which PHPs already designate people with SCD as a priority population. Member handbooks for the plans do not mention comprehensive assessments and individualized care plans for enrollees with SCD, but interviews with some plans demonstrate that they recognize enrollees with SCD have complex health care needs that require comprehensive support.
4.2 Quality Measures NC Medicaid should assess PHP performance on outcomes for people with SCD. Implementation: • NC Medicaid should convene a workgroup of stakeholders, including people with SCD, to determine appropriate quality measures for SCD. • NC Medicaid should add quality measures for SCD to “Required PHP Quality Metrics” that measure PHP performance. North Carolina Context
NC Medicaid’s PHP contract requires PHPs to report a set of quality and administrative measures to assess the PHP’s processes and performance and, “beginning in Contract Year 3, the Department may implement withhold measures based on quality measures used to administer a PHP quality withhold/incentive program”.285 The list of required PHP quality metrics totals 66 quality measures and includes measures like “Medication Management for People with Asthma”, “Comprehensive Diabetes Care”, “Statin Therapy for Patients with Cardiovascular Disease”, among others. NC DHHS has the right to add additional quality metrics, providing opportunities to leverage quality metrics to identify weaknesses and prioritize populations. NC Medicaid’s PHP contract does not include any quality measures that assess the PHP’s performance with SCD. Without quality measures and the quantification of outcomes and disparities for patients with SCD, it is difficult to determine where existing gaps are and develop effective interventions.
56 Part II. Sickle Cell Disease Recommendations
