According to a recent Commonwealth Fund report, Americans pay more for brand-name drugs than residents of most other countries, including Japan, the United Kingdom, Australia, Germany, France, Canada and Switzerland. From January 2022 to January 2023, the prices of over 4,200 drug products rose, with nearly half exceeding the rate of inflation and an average price increase of $590 per drug product. The rising cost of prescription drug prices in the United States has created challenges for taxpayers, healthcare payers, employers and most importantly patients.

Nearly one in four Americans taking prescription medications say it’s difficult to afford them. The financial burden has led many to take cost-saving measures such as skipping or delaying filling a prescription, missing or reducing doses, or using someone else’s medication, drawing attention to the critical issue of medication adherence.

What Is medication adherence?

Medication adherence is the act or extent of conforming to a provider recommendation/prescription based on timing, dosage and frequency of medication use.

 Why is medication adherence important?

Medication adherence is a primary determinant of treatment success and one of the most important things an individual can do for their health. Failing to follow prescribed medication regimens can have serious consequences for the nearly 67% of Americans who are non-adherent.

• Reduced effectiveness—Medications may not work as intended, leading to inadequate management of health conditions. Non-adherence can account for up to 50% of treatment failures.
• Worsening symptoms—Failure to adhere to prescribed treatments may result in the exacerbation of symptoms or disease progression. According to the CDC, nearly 50% of adults suffer from chronic diseases, such as diabetes and hypertension. Nearly half of these do not adhere to prescribed medication regimens. This failure to adhere is believed to contribute to a minimum of 100,000 preventable deaths and $100 billion in preventable medical costs annually.
• Complications and side effects—Skipping doses or not following medication instructions may contribute to adverse effects or complications. Appropriate medication treatment has the potential to prevent approximately 89,000 premature deaths annually among hypertensive patients.
• Lack of productivity—For chronic conditions, non-adherence may result in a decline in productivity due to increased sick days or disability. If a group of 1,000 employees with diabetes collectively improves their treatment adherence by 10 percent, it could reduce short-term disability and lost work time up to 441 workdays, resulting in potential employer savings of around $94,000.
• Decreased quality of life—Non-adherence may diminish overall wellbeing and hinder individuals’ ability to maintain a satisfactory quality of life. The risk of death due to medication non-adherence is approximately ten times higher than the risk of homicide, escalating to around 30 times for individuals over 50. Morbidity and mortality associated with poor medication adherence costs $528.4 billion annually.
• Risk of hospitalization—Lack of adherence increases the likelihood of severe health events, potentially requiring hospitalization. Twenty percent of Medicare patients are readmitted to the hospital within 30 days. Fifty percent of these are considered non-adherent. Non-adherence can be attributed to up to 25% of hospitalizations in the United States annually.
• Impact on public health—Non-adherence is recognized as a significant public health issue. It leads to poor health outcomes and increased healthcare costs, and can have broad implications for public health, especially when it comes to the management of chronic conditions. As many as 59% of individuals with mental illness inconsistently or do no take their medication. This behavior contributes to broader societal problems, including increased rates of suicide, and increased rates of unemployment and homelessness.
• Increased healthcare costs—Non-adherence can lead to more frequent doctor visits, hospitalizations, and additional medical expenses. Addressing medication adherence has the potential to reduce annual healthcare costs by $100 to $300 billion.

Research has repeatedly found that the primary factor impacting medication adherence is cost. In light of this challenge, innovative programs like Magellan Healthcare’s inforMED Pharmacy Program offer a promising solution by ensuring behavioral health and other medications are prescribed and managed effectively. Visit here to learn more about inforMED and how it reduces pharmacy spend with a 2:1 ROI and gaps in care by up to 40%.

Sources:

• 15 Frightening Stats on Medication Adherence (Plus Infographic) (pillsy.com)
• Changes in the List Prices of Prescription Drugs, 2017-2023 | ASPE (hhs.gov)
• Medication Adherence: The Elephant in the Room (uspharmacist.com)
• Medication Adherence and Compliance: Recipe for Improving Patient Outcomes – PMC (nih.gov)
• Medication Adherence Measures: An Overview – PMC (nih.gov)
• International Price Comparison of Drugs Medicare Is Negotiating (commonwealthfund.org)
• Products – Data Briefs – Number 470 – June 2023 (cdc.gov)
• The Unmet Challenge of Medication Nonadherence – PMC (nih.gov)
• The Workplace Costs of Not Taking Your Medication | The Pursuit | University of Michigan School of Public Health | Chronic Disease | Statistics | Health Informatics | Pharmaceuticals (umich.edu)

National Healthcare Quality Week, observed on October 15 to 21, celebrates the many healthcare quality professionals who tirelessly work toward ensuring that quality service is delivered. This week is also a time to spread awareness of the importance of quality healthcare services and create policies that facilitate the safety of both patients and healthcare professionals.

In honor of National Healthcare Quality Week, we’re spotlighting Magellan Health’s Allie Kelley, quality specialist. Some of Kelley’s responsibilities to ensure quality healthcare include managing certain member notifications, generating internal reports for customer requirements, and assisting with EAP record requests within our Employee Assistance Program (EAP) provider network. Continue reading to learn more about Kelley’s work in healthcare quality:

What sort of projects are you currently working on?

I am brand new to the responsibility of running a Quality Improvement Activity (QIA) so I’m learning responsibilities such as barrier analysis, which examines limitations or obstacles to the efficiency of a process or desired outcome, investigating root causes, developing, and discussing interventions, and ongoing monitoring are my biggest tasks right now.  I am very excited about how this process can improve the level of service we provide to our members. It is awesome to have different department leaders come together to talk about barriers and interventions to improve identified metrics and then be able to measure the success of these interventions.

Why is Magellan Health the best place to do this project?

Magellan’s values include integrity, accountability, knowledge, collaboration, caring, creativity, and results. Every one of those values is critical to the success of any QIA. Leadership also shows great support of the overall QI department, and ultimately Magellan as a whole.

What are your thoughts on the culture here at Magellan?

I have been a part of Magellan Health for 25 years and have had the opportunity to work in many different roles. I have seen this company grow in the healthcare industry, and I have never once doubted how much Magellan cares for and believes in their employees. Magellan has been an industry leader when it comes to diversity, equity, and inclusion, and offering comprehensive employee benefits.

Beyond that, the member lives we cover, especially the most vulnerable populations, have always been the most important thing to me in every position I’ve held here. Magellan’s philosophy and mission have always aligned with this. Positively influencing the health and wellbeing of our members has always been a top priority throughout this organization.

How did you get involved with the Healthcare Quality field?

My heart and my passion have always been with our members and working to make sure they are receiving the best care possible. I am a social worker at heart, so when I read the job description for my current role, it was very clear to me that the role in a strong Quality Department is not at all separate from what my mission in the clinical department had always been! I became excited about the possibility of stepping out of my comfort zone while keeping in mind what I came here to do, which is to help people.

What are some of the most challenging and rewarding aspects of working in Healthcare Quality?

Some of the more challenging aspects have been learning the more technical side of things, while the most rewarding part of being in this department has been being a part of a team so committed to integrity, accountability, and data driven results. This is demonstrated in the preparation of the annual Trilogy documents, where everyone on the team comes together to work toward a common objective. Trilogy is our annual evaluation of the QI Program that evaluates outcomes, reviews effectiveness, assesses goal achievements, evaluates the deployment of resources, documents, and trends input from advisory groups. Seeing that final document come together was amazing. I was so proud to have contributed to that and we are getting ready to do it all over!

What does Healthcare Quality Week mean to you? Is there anything else you’d like to highlight about Healthcare Quality?

Healthcare Quality Week to me is a time to raise awareness of the positive impact healthcare quality professionals have in our organizations and communities. At Magellan Health, healthcare quality is organized around the positive influence of the health and wellbeing of individuals by identifying gaps in care and service, improving clinical outcomes, assuring patient safety, and adding value through efficiency. In healthcare quality we’re also focused on enhancing services and the individual’s experience of care. We also work to assure that all core business processes are innovative and meet or exceed contract, regulatory, and accreditation guidance while leading to system and cost efficiencies.

Learn how to prepare your family and community

Every September, the United States observes National Preparedness Month as a reminder of the significance of proactive planning and community engagement in the face of adversity. This initiative calls for individuals, families, and communities to assess their readiness and take steps to prepare for emergencies in their homes, businesses, schools, and communities. National Preparedness Month encompasses prevention, protection, response, and recovery efforts to prepare the United States for all threats – whether they are natural or man-made disasters.

The concept of preparedness extends far beyond stockpiling canned goods. It involves a holistic approach encompassing mental, physical, and logistical readiness. At the individual level, being prepared means having a well-thought-out plan that addresses each person’s and family’s unique needs. This includes knowing how to contact loved ones during a crisis, understanding the emergency procedures of workplaces and schools, and having essential supplies readily available.

National Preparedness Month was established in the aftermath of the tragic events of September 11, 2001. In response to the9/11 attacks, the Federal Emergency Management Agency (FEMA) and the Department of Homeland Security (DHS) collaborated to establish a nationwide campaign aimed at raising awareness about emergency preparedness. FEMA’s “Ready” campaign was launched in 2003 as a national public service campaign to educate and empower Americans to prepare and respond to emergencies.

Tips to Prepare for an Emergency

Ready.gov (for Spanish, see Listo) asks individuals to do four things:

1. Stay informed about the different type of emergencies that could occur and their appropriate responses.
2. Make a family emergency plan.
3. Build an emergency supply kit.
4. Get involved in your community by taking action to prepare for emergencies.

Each year, National Preparedness Month focuses on a specific theme that highlights an aspect of preparedness and resilience. These themes are selected to address evolving challenges and empower individuals and communities with the tools and knowledge needed to navigate emergencies effectively. This year’s theme is Preparing Older Adults for Disaster.

Available Stress Counseling Services

Magellan Federal has proudly been providing stress counseling services to FEMA since 2001. Stress counseling is on-demand disaster-driven behavioral health stress counseling services to support FEMA employees while providing critical disaster response. Services include one-on-one counseling, employee management consultation, Psychological First Aid, assessment and referral, crisis intervention, program briefings, wellness talks, psychoeducational grief groups, and walkabouts. Since 2021, Magellan Federal has provided stress counseling services to over 40 disasters and 16,000 individuals.

Through awareness, education, and action, National Preparedness Month empowers communities to come together to share resources, knowledge, and support. Together, we can build a more resilient and secure future for ourselves and our communities. For more information about emergency preparedness and to start building your own emergency plan, visit Ready.gov.

Suicide claimed the lives of almost 46,000 people in the United States in 2020.[1] It is the second leading cause of death for children aged 10–14 and adults aged 35–44, and the third leading cause of death for young people aged 15–24.[1]

Now is the time to raise awareness and reduce the stigma surrounding suicide. Learn more about the warning signs and what you can do if you suspect someone is thinking about suicide. Be the one to save a life.

Know the warning signs

• Hopelessness
• A negative view of self
• Aggressiveness and irritability
• Making suicide threats
• Increased alcohol or drug use
• Withdrawing from friends, family and society
• Trouble sleeping or sleeping all the time
• Changes in mood or behavior
• Feeling like a burden to others and giving things away

Take time to reach out

You can help give someone hope by showing that you care. Notice what is going on with people in your life—a family member, friend, colleague or even a stranger. By stepping closer and reaching out, you can become aware of those around you who may need help. You do not need to tell them what to do or have solutions. Simply making the time and space to listen to someone talk about their experiences of distress or suicidal thoughts can help.

Don’t be afraid to ask someone if they are suicidal

You may not think it is your place to intervene, you may be afraid of not knowing what to say and/or you may be worried about making the situation worse. Offering support can reduce distress, not worsen it. When someone is upset, they are often not looking for specific advice. What you can do is listen without judgment, be compassionate, and know about resources to get help like the 988 Suicide and Crisis Lifeline (call, text or chat).

Additional suicide prevention resources and upcoming webinar

Register for our free webinar, “The role of mental health recovery in suicide prevention,” on September 22 to hear the inspiring recovery story from Stacey Volz, CPRP, CPS, Magellan Healthcare family support coordinator and a person who lives with mental health challenges and has lived through multiple suicide attempts. I will also be on the panel to share my knowledge and professional experience in addressing mental health and substance use challenges to prevent suicide, along with Andrew Sassani, MD, Magellan Healthcare chief medical officer, California, HAI and MHS, and Samuel Williams, MD, MBA, FAPA, Magellan Healthcare medical director.

Visit Magellanhealthcare.com/Prevent-Suicide for more information and materials to learn more and spread awareness about suicide prevention.

[1] National Institute of Mental Health, “Suicide” information

Affirmative Care for Transgender and Gender Nonconforming Persons

There are an estimated 14,700 transgender and an unknown number of non-binary individuals serving in the U.S. military today. Magellan Federal provides non-clinical counseling on military bases around the world. We draw on that experience to provide guidance on how to create a respectful culture in military environments as well as in your community.

Read the full article on MFed Inform

While up to 80% of all primary care visits include a behavioral health component, primary care providers (PCPs) may feel overwhelmed and ill-equipped to meet their patients’ behavioral health needs. Collaborative care can help.

What is collaborative care?

Collaborative care is a specific type of integrated care that uses a team-based, patient-centered approach to address behavioral health in the primary care setting. Collaborative care links a patient’s PCP with a behavioral health care manager and psychiatric consultant to help meet their mental health goals. This approach has been studied in over 90 different randomized control trials and has shown to be highly effective in delivering a better patient experience, as well as improving patient outcomes and providing cost reduction.

Collaborative care gives PCPs the tools and support they need to manage ongoing mental healthcare and helps improve the quality of care provided.

• A patient registry allows PCPs to track patients and ensure that no one falls through the cracks. Patients who do not show improvement are outreached, and behavioral health specialists offer caseload-focused consultation.
• Screening tools, such as the Patient Health Questionnaire (PHQ)-9 for depression and the Generalized Anxiety Disorder (GAD)-7 for anxiety, help identify and direct patients to the appropriate levels of care for mental health conditions.
• A behavioral health care manager supports the PCP in myriad ways, including:
  • Ensuring effective communication among the team
  • Coordinating the team and mental health treatment
  • Providing progress updates and treatment recommendations to the provider
  • Alerting the PCP when the patient is not improving
  • Supporting medication management
  • Facilitating communication with the psychiatric consultant regarding treatment changes
  • Conducting brief interventions, such as motivational interviews with patients to guide their progress
• A psychiatric consultant reviews cases alongside behavioral health care managers and assists the care team with treatment planning, and diagnostic and treatment recommendations.

Collaborative care allows patients to get mental healthcare where they regularly seek physical healthcare, rather than having to go elsewhere.

 Throughout the U.S., individuals lack access to mental healthcare. In fact, over 26 million individuals experiencing a mental health condition are going untreated. Providing mental healthcare in the primary care setting allows patients to:

• Address mental health concerns with a provider they trust and see regularly for physical health concerns
• Receive mental health treatment at an earlier stage to help prevent more serious problems
• Have regular contact with a behavioral health care manager who can deliver brief interventions and individualized care planning
• Receive coordinated care for co-occurring mental and physical conditions
• Reduce the burden they carry in communicating treatment updates to multiple providers when they have comorbid physical and mental health concerns
• Feel comfortable that all of their health needs are being addressed
• Receive mental health treatment that is often less expensive

Magellan Healthcare’s collaborative care solution, powered by NeuroFlow

 Collaborative care has been proven to double the effectiveness of depression care, as well as improve physical function and reduce healthcare costs. Magellan Healthcare’s evidence-based Collaborative Care Management solution for health plans and healthcare delivery systems provides care management and psychiatric consults for primary care patients and augments physical health providers’ staff with Magellan staff to facilitate integrated physical and behavioral healthcare. Learn more here.

Sources:

• 2020 Adult Data | Mental Health America (mhanational.org)
• Benefits of Behavioral Health Integration for Primary Care Providers | Bipartisan Policy Center
• Collaborative Care | University of Washington AIMS Center (uw.edu)

Haita Makanji, vice president, clinical strategy and innovation supporting the specialty division of Magellan Rx Management, has worked for MRx for nearly 10 years, where she has focused on helping to support payers as they navigate the pharmacy space. Makanji, who is based out of Massachusetts, leads a team of highly trained pharmacists and experts in development and implementation of clinical solutions for customers in various high-cost specialty conditions across both the medical and pharmacy benefits including but not limited to cancer, hemophilia, and rare diseases. Her team focuses on utilization management, dose optimization, care management and technology-based programs for commercial, Medicare and Medicaid patients across the country. Continue reading to learn more about the innovative projects Makanji and her team are working on in the pharmacy space:

What sort of projects are you currently working on?

I’m passionate about working closely with payers and supporting them as they navigate the evolving landscape of new, expensive treatments, while also helping to deliver the highest quality of care to patients. For exceedingly high-cost specialty conditions, our emphasis is always on value through delivering clinical solutions that offer the most appropriate treatment to patients while combating the rising spend payers are facing.

For example, a recent project centers on a one-of-a-kind solution for payers focused on precision medicine in the oncology space, which is the highest-spend category for specialty drugs on the medical benefit for over 10 years. This is an exciting, next-generation pharmacy initiative where we will be combining genomic testing with drug selection for providers who treat cancer patients and meeting a critical need for payers who are looking for more complete solutions on both the medical and pharmacy benefit.

In 2021, we launched a comprehensive high-cost therapy program to provide enhanced utilization management strategies and case management referral for ultra-rare diseases. Payers often struggle to identify specialized experts, either internally or within their network, so our ability to leverage our MRx Expert Clinical Network of more than 175 key opinion leaders who practice various specialties, combined with our team of experts, offers a unique opportunity to support treatment decisions that leads to better health outcomes.

Why is Magellan the best place for these projects?

I’m proud to work for an organization that has a deep understanding of medical and pharmacy trends and a history of pioneering industry-first solutions for specialty drug management. With 17 years of experience in managing specialty conditions, we are unique in the marketplace.  Our customers routinely expand their collaborations with us because we continuously elevate our suite of solutions with innovative and forward-thinking approaches. Our mission is to help patients live healthy, vibrant lives and we accomplish this by ensuring that the right patients receive the right therapies at the right time.

What are your thoughts on the culture here at Magellan? How has that culture impacted your work?

We have a family-oriented culture where we collaborate and have a true understanding and trust of each other. Magellan fosters an environment that encourages open, honest feedback in all teams. Magellan also provides employees with the opportunity to challenge themselves and embrace new opportunities. This is imperative as we innovate and bring new programs to the market.

What exciting trends are you noticing in the healthcare industry? In what direction do you see healthcare going and what lessons are there to learn from other industries that can be applied to healthcare?

I’m energized by how quickly our industry is adapting to new technologies and advancements in the delivery of healthcare. Particularly in digital health solutions with the shift towards value-based care strategies and the pivot to personalized medicine.

The market will need to be laser-focused on providing clinically appropriate, personalized care at the lowest cost for both payers and patients.

One lesson we can take from other industries is the ability to be nimble and flexible. Disruptors in every sector of healthcare are bringing new offerings directly to consumers in the hopes that simplicity and transparency will cultivate consumer loyalty. We can take advantage of the availability of data and deployment of new technologies to respond quickly to changing market dynamics and the needs of our customers and their unique patient populations. While we have a proven track record and hundreds of successful case studies across our suite of solutions, it’s important that we never stop innovating!

Men, women, and children. Black and white. Rich and poor. Depression affects Americans from all walks of life, regardless of age, gender, race, ethnicity, and socioeconomic status. In fact, the Centers for Disease Control and Prevention estimate that one in thirteen of us is living with depression.[1]

• In 2019, nearly 13 million U.S. adults and 2.7 million U.S. adolescents had at least one major depressive episode with severe impairment in the past year[2], including:
  • Almost 10% of females and 6.0% of males[3]
  • Approximately 15% ages 18-25, 9% ages 26-49, 5% ages 50+[4]
  • About 7% Hispanic or Latino, 9% White, 6% Black or African American, 5% Asian, 4%[5] Native Hawaiian/Other Pacific Islander, 9% American Indian/Alaskan Native[6]
• About 31% of Americans in poverty and almost 16% of those not in poverty report having been diagnosed with depression [7]

Recognizing signs of depression

Depression is often referred to as a silent illness. Many people who suffer from depression secretly struggle and never seek help. Signs and symptoms of depression include:

• Low mood or increased irritability
• Feeling empty or numb
• Loss of energy or motivation
• Loss of interest in regular or recreational activities
• Feelings of guilt, restlessness, hopelessness, worthlessness or fear
• Sleeping too much or too little
• Changes in appetite or eating behavior
• Poor concentration
• Suicidal thoughts

If you or someone you love is experiencing any of the common risk factors and warning signs associated with depression, online or in-person depression screening is the first step toward improved mental health and wellbeing.

Benefits of depression screening

Screening is a valuable tool in the identification and treatment of depression. One of the most common screening tests for depression is the Patient Health Questionnaire (PHQ). Early identification and treatment of depression can:

• Slow its progress
• Improve your physical health
• Prevent years of suffering
• Decrease the risk of death by suicide
• Place you on the path to a happier, healthier life

Visit here to complete the PHQ-8. Once you complete the assessment, be sure to review your results and any recommendations with your doctor.

Who should take a depression screening test?

The U.S. Preventive Services Task Force recommends screening for depression in the general adult population, including pregnant and postpartum women. Although anyone can develop depression, regardless of their age, ethnicity, or background, depression is more common among people who:

• Have a family history of mental illness
• Have another mental health condition, like anxiety
• Struggle with a substance use disorder, like drug addiction or alcoholism
• Recently experienced a stressful life change or traumatic event

However, anyone who has any signs of depression should take a depression screening test.

Screening and treatment

While screenings are not a professional diagnosis, they do point out the presence or absence of depressive symptoms and can indicate if a referral for further evaluation is needed. You should see your doctor or a qualified mental health professional if you experience five or more depression symptoms for longer than two weeks or if the symptoms are severe enough to interfere with your daily routine.

Proper treatment of depression has been proven to effectively reduce depressive symptoms, decrease the risk of relapse and recurrence, and decrease emergency department visits and hospitalization rates.

Learn More

Visit Magellan’s Behavioral Health Resources page to learn more about depression and other mental health conditions.

If you’re in crisis or have suicidal thoughts, seek help immediately. Please call 1-800-273-8255 (National Suicide Prevention Lifeline) or call 911 and ask for help, or go to your nearest emergency room.

[1] https://www.cdc.gov/tobacco/campaign/tips/diseases/depression-anxiety.html

[2] https://www.nimh.nih.gov/health/statistics/major-depression

[3] https://www.nimh.nih.gov/health/statistics/major-depression

[4] https://www.nimh.nih.gov/health/statistics/major-depression

[5] https://www.nimh.nih.gov/health/statistics/major-depression

[6] https://www.nimh.nih.gov/health/statistics/major-depression

[7] https://news.gallup.com/poll/158417/poverty-comes-depression-illness.aspx