Medicaid managed care transformation and acute and routine care visits among youth with sickle cell disease

In July 2021, North Carolina Medicaid transitioned to a managed care (MMC) system. We investigated how MMC transformation changed acute and routine care visits among youth with sickle cell disease (SCD) and other chronic conditions. We identified patients with SCD enrolled in Medicaid 2 years before and after MMC transformation and followed by a pediatric hematology/oncology clinic. Comparator groups included children in the same health system and diagnosed with chronic kidney disease (CKD), type 1 diabetes mellitus (T1DM), and hemophilia. The primary outcome was the number of acute care visits per patient in each period. The secondary outcome was the likelihood of missing routine visits at the subspecialty clinic. We identified 197 patients with SCD, 59 with CKD, 169 with DM, and 18 with hemophilia. After MMC transformation, analysis revealed the number of acute care visits for the SCD cohort increased by 19% 95% CI [8%–32%], with no improvement in completing routine clinic visits. Acute care visits increased in the T1DM cohort, although routine visit completion improved among patients with CKD. After MMC transformation, acute care visits increased among SCD patients. Targeted efforts are needed to realize the potential of MMC transformation for improving care.