Summary of Recommendations

Part I. Recommendations To Improve Both Sickle Cell Disease and Maternal Health Outcomes

Rural Health • NC DHHS should convene a working group with two subcommittees—one for SCD and one for maternal health—to develop best practice standards for establishing hub and spoke models of care.

Transportation • NC Medicaid should offer ridesharing as a form of Non-Emergency Medical Transportation (NEMT). • NC Medicaid should provide NEMT tailored to the needs of pregnant and postpartum women.

Provider Bias Training

• NC DHHS should expand and improve its implicit bias training requirements to include perinatal and SCD providers.

Non-Medical Drivers of Health

• NC DHSS should increase resources in NCCARE360 and CBOs to ensure their ability to address non-medical drivers of health.

Data Gaps • NC DHHS should ensure the public has access to timely and useful data.

Part II. Sickle Cell Disease Recommendations

Care Management • Pediatric to Adult Transition Care Models. NC Medicaid should encourage support during the transition of pediatric patients with SCD into adult care. • 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. • DPH Existing Programs. NC DHHS should support legislation to increase funding for the NC Sickle Cell Syndrome Program to ensure continuous care and treatment for people with SCD.

Access to Care and Services

• Telehealth. NC Medicaid should cover physician and hospital outpatient telehealth services at parity for people with complex care needs, including the Medicaid population that experiences SCD. • Sickle Cell Day Hospitals. NC DHHS should bolster established SCD day hospitals in North Carolina.

Evidence-Based Clinical Care Models

• Hydroxyurea. NC Department of Health Benefits (DHB) should aim to improve hydroxyurea (HU) access and uptake among people with SCD. • Pain Management. NC Medicaid should require PHPs to take steps to improve pain management approaches within the SCD population. • Red Blood Cell Molecular Testing. NC Medicaid should expand required newborn traditional blood testing. • Transcranial Doppler Ultrasonography. NC Medicaid should facilitate annual transcranial doppler ultrasonography (TCD) screening for children with SCD aged 2 to 16.

Leveraging Prepaid Health Plan Contracts

• Priority Population. NC Medicaid should include “people with sickle cell disease” as a priority population in PHP contracts. • Quality Measures. NC Medicaid should assess PHP performance on outcomes for people with SCD. Payment Models • Incentive Programs. NC Medicaid should explore innovative payment models, such as incentive programs, to increase utilization of recommended SCD treatments and improve SCD health outcomes. • Subscription-Based Payment Models. NC Medicaid should explore innovative payment models, including SubscriptionBased Payment Models (SBPMs), to increase utilization of new therapeutics and improve SCD health outcomes.

Part III. Maternal Health Care Recommendations

Care Management • Home Visits. NC Medicaid should expand the coverage and quality of services provided through home visiting programs. • Postpartum Continuity of Care. NC Medicaid should improve access to and continuity of care during the postpartum period. Care Services • Doula Services. NC Medicaid should cover and support doula services. • Group Prenatal Care. NC Medicaid should require PHPs to cover group prenatal care.

Access to Care and Services

• Midwife Workforce. NC DHHS should support changes to the state midwifery certification and reimbursement processes.. • Screening of Perinatal Mental Health Conditions. NC Medicaid should incentivize PHPs to conduct perinatal mental health screenings. Quality Measures • NC Medicaid should encourage PHPs to decrease disparities in maternal health outcomes.

Administrative Burden • NC Medicaid should reduce administrative burdens that keep pregnant and postpartum enrollees from enrolling in Medicaid. • NC Medicaid should improve enrollees access to translation services during perinatal appointments.