Precision medicine is the concept of tailoring disease treatment and prevention to account for differences in genetic, environmental, or even lifestyle factors specific to groups of people.¹ Precision medicine takes genetic and biochemical information unique to a group of patients and uses that information to develop more specific and streamlined medications or treatments. The goal is to ensure that each medication or treatment is best suited to treat the individual, resulting in decreased side effects and increased effectiveness.²

Precision vs Personalized Medicine

Although the terms precision medicine and personalized medicine are used interchangeably, there can be nuanced differences. The National Research Council (NRC) issued a statement saying that the term “personalized medicine” can refer to a treatment that may be completely individualized to a specific patient, which is not the true definition of precision medicine.³ The difference here is that precision medicine seeks to create treatments that are applicable to groups of individuals who meet certain characteristics. This is different from “personalized medicine,” which implies individualized treatments available for every unique patient.

Current Landscape

In 2015, the Precision Medicine Initiative (PMI) was launched, with $215 million dollars invested into precision medicine research.⁴ A new program was created—All of Us Research Program—which had the goal of recruiting 1 million Americans and creating a nationwide database for research.⁵ Other examples of precision medicine initiatives include the Geisinger Health System’s National Precision Health Initiative, the Partnership for Accelerating Cancer Therapies (PACT), and Cancer Moonshot.¹ There has been particular success in the field of cancer, with new medications developed for a specific cancer types with certain genetic characteristics. With increased funding, decreased costs to sequence DNA and analyze genetic information, and improved data analytics, many believe precision medicine to be the future of healthcare delivery.

1. Bresnick, Jennifer. 2018. “What Are Precision Medicine and Personalized Medicine?” HealthITAnalytics. HealthITAnalytics. January 11, 2018. https://healthitanalytics.com/features/what-are-precision-medicine-and-personalized-medicine.
2. Genetics Home Reference. n.d. “What Is the Difference between Precision Medicine and Personalized Medicine? What about Pharmacogenomics?” Genetics Home Reference. Accessed October 11, 2019. https://ghr.nlm.nih.gov/primer/precisionmedicine/precisionvspersonalized
3. Council, National Research, Committee on a. Framework For Development a. New Taxonomy of Disease, and Others. 2010. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. National Academies Press.
4. “FACT SHEET: President Obama’s Precision Medicine Initiative.” 2015. Whitehouse.gov. January 30, 2015. https://obamawhitehouse.archives.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative.
5. “Program Overview – All of Us | National Institutes of Health.” n.d. Accessed October 11, 2019. https://allofus.nih.gov/about/all-us-research-program-overview.

“For a turtle to walk forward, it has to stick its neck out. Because Wraparound challenges systems to support families in unique and strength-based ways, staff must take chances when doing things differently than has been done in the past. Hence, they stick their necks out for change and work toward a better future for children, youth and their families.” – National Wraparound Implementation Center

Our challenge as wraparound providers is to stick our necks out for change! We are all working for a better future for the children, youth and families in Wyoming. Though our roles may differ, the objective is the same. Keep more youth at home, in school and out of trouble.

I have had High Fidelity Wraparound graduates tell me, “You saved our family.” The comments are heartfelt and genuine. But in wraparound, we don’t save their family. We do our duties with respect and fidelity. We show up for families, have hard conversations, reframe thoughts and ideas into action items and create tangible goals. We help them start to build a solid team of “go to” people and supports. We give a lot of suggestions and do a lot of work. But we alone, do not save their families.

They save their family. They do the hard stuff. They listen when they don’t yet understand how things could be different. They show up to their wraparound meetings and start to learn the process. They work to strengthen relationships needed for more natural supports. They are brave enough to question systems and processes that don’t work for them. They try new things, even though they are unsure of the outcome. They trust a stranger, like me, who shows up to help. They believe in me, and I believe in them. They keep on building trust in each other and confidence in their own abilities. They keep doing this work until one day they don’t need me anymore. It’s not as if everything is changed, fixed and all challenges solved. They did grab onto a life preserver when it was thrown. They did all the hard stuff to save themselves. That’s the true work. As wraparound providers, we share in the work load, but it is not all ours to do. Not even close.

Some families that I hear from I have worked with over 10 years ago. I believe this is because we built solid connections which are genuine. I stuck my neck out and let people know how to reach out if they ever need me, even after they transitioned from wraparound. What stands the test of fidelity to the model of wraparound is not how many youths are “saved”, but how many families and individuals we influence to create lasting and positive change in their lives. The relationships we build is what sets the stage for how well the process of wraparound gets incorporated into everyday life. We must be brave and risk our necks at times to build authentic relationships with people. We are all vulnerable. Sticking our necks out for the right reasons, at the right time and in right way, keeps Wyoming’s families moving forward.

Who’s with me? Turtles unite!

Prior authorization (PA) goes by many names—preauthorization, preapproval, advance notification, precertification and preadmission, to name a few. All these terms refer to the utilization management (UM) process used by many U.S. health insurance companies to ensure patients receive the right services, equipment and prescriptions at the right time and place. PA requires healthcare providers to request and obtain approval before rendering certain services, equipment or prescriptions in order to receive insurance reimbursement for those services. Not everything requires PA. Typically, authorization is needed for more complex services such as hospital admissions, diagnostic tests, medical equipment and complex prescription medications.

The PA process is intended to act as a safety and cost-saving measure. It can lower costs to the patient, prevent unnecessary or invasive procedures, and reduce the use of unnecessary tests that may expose patients to potentially harmful radiation and/or undue stress. For example, up to half of advanced imaging procedures ordered fail to provide information that improves patients’ welfare.[i] In addition, despite studies demonstrating overuse, rates of advanced imaging procedures continue to rise—increasing costs and exposing consumers to excessive radiation.  Despite its benefits, the prior authorization process needs an upgrade.

According to the 2018 CAQH Index , manual prior authorizations (via fax or telephone) are the second most-costly medical administrative transaction, costing providers $6.61 per submission. Providers estimate their staff members spend up to 30 minutes completing one manual prior authorization. While manual prior authorization is a much-debated topic due to the time and cost it requires, many parties support standardizing and simplifying the process.

Technology can significantly  decrease the need for expensive manual processes.  According to the 2018 CAQH Index, the medical industry could save $417 million annually by transitioning to electronic prior authorizations, which includes $278 million in annual savings for providers and $139 million for health plans.

While many health plans offer web portals to process prior authorizations, this approach requires providers to use different online systems for each health plan. Instead, digital solutions should include automation within the electronic health record (EHR) and the physician’s workflow. Automation is essential to reducing inefficiencies for providers and health plans and enabling authorizations at the point of care while maintaining clinical integrity.

The goal is to make the right decision for each patient—quickly and easily so patients get the care they truly need. Automating prior authorizations will benefit everyone involved.

[i]Beachy, D. (2014, September 8). Defensive medicine driving up wasteful imaging. Retrieved from https://www.healthimaging.com/topics/healthcare-economics-policy/defensive-medicine-driving-wasteful-imaging.

Care is core to every service we deliver and everything we do at Magellan Health. Through our work, we are listening, learning and using our collective insight to make a difference in the lives of those we serve.

Wyoming’s High Fidelity Wraparound program is just one of many examples where Magellan team members, who have lived through similar experiences, are returning the favor and providing the care and concern they consider themselves fortunate to have also personally received.

High Fidelity Wraparound is a voluntary planning and care coordination process for children and young adults (ages 4-20) with complex behavioral health conditions. High Fidelity Wraparound’s community-based solutions and planning process bring people together from different areas of a family’s life to form a team. The team, led by a Family Care Coordinator, creates steps to help youth stay in their homes, schools and communities.

Through collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan serves as the Care Management Entity for the High Fidelity Wraparound program, setting the rules and providing training for everyone involved in the process.

One of Magellan’s certified Family Care Coordinators, a person responsible for managing a High Fidelity Wraparound team, recalls the story of a recent family she worked with. “In December, the family’s generator went out and without power they had to leave their home. As a result, the family had to move which was highly disruptive and caused a lot of tension within the family as their culture is centered on independence. In addition, it was upsetting to a young member of the family as the unfamiliar environment became very troubling.”

Living away from home negatively impacted progress the youth was making before having to move. Relationships were being affected and everything for this youth became more difficult. The family requested help to get back to their property through Magellan of Wyoming. Their Family Care Coordinator said, “When we found out our flex funds were approved to help get them home, [mom] cried and I did as well. This family finally felt hope, and there could now be a clear plan to help them move back home.”

Tammy Cooley, senior operations director at Magellan Healthcare of Wyoming, said, “We are honored to provide a means for a family to get back to their home, and keep their youth with them. Sometimes, we see families in situations where youth cannot remain at home. When we can fill a need and keep a youth safely at home because it’s the right thing to do, we will do that. The work we do, at the very core, is about the success of youth and families being able to meet their needs in positive ways.”

The single most important thing you can do to help your children is to show that you love them no matter what. Knowing that you are close by and available gives your children a sense of security. Although your children’s world is expanding, you remain their primary influence.
Always remember that you are a role model.

Your children learn by watching you. So be sure that your actions and behaviors teach them how to:
• Show love and affection.
• Control anger.
• Work with other people rather than against them.
• Stay calm.
• Look forward to tomorrow.
• Express feelings.
• Be brave.
• Laugh.

Safety and security
To build inner strength, children need to feel loved and safe. They need a family that is close, that spends regular time together, and that offers a safe haven as they grow.
• Make sure that your child feels safe. Your child is more likely to feel safe and secure if you are dependable, consistent, respectful, and responsive. These qualities are especially important for parents of preschool children, because these children are gaining a basic sense of trust in themselves and in the important people in their lives.
• Encourage safe exploration. Children need to explore. Children who explore learn new skills and how to solve problems. They learn that actions have consequences, and that causes have effects. Offer a variety of things to play with, read, create, and build. It might be hard, but try not to limit your child because of safety fears. Instead, do what you can to keep the child safe as he or she explores the world.

Social support
• Help your child build social skills. Teach your child by showing your acceptance of others and not gossiping or saying mean things about other people.
• Provide peer contact. Playing with other children even 1 day a week gives children opportunities to learn and practice important social, emotional, and language skills. Children learn to share, cooperate, and negotiate as they interact with their peers. Around age 9, many children successfully form close friendships. Forming these relationships helps children learn sensitivity to the feelings of others.

Confidence and independence
• Encourage independence. Children learn a sense of independence by practicing skills and doing things for themselves, such as getting dressed or brushing their teeth. Children who are not allowed to perform tasks on their own get the message that they are not capable.
• Help your child build self-esteem. Parents have the greatest influence on a child’s belief about himself or herself. Letting children know that they belong, are doing well, and are contributing can help them build healthy self-esteem.
• Reduce stress. Teach your child how to manage stress. Controlling stress increases resilience.
 Stress Management: Helping Your Child With Stress
• Deal with fears. Understand that your child may become extremely interested in scary subjects or images as a way to overcome them. Help your child as much as you can by answering questions and providing reassurance as needed.
• Recognize and develop special talents. To build healthy self-esteem, all children need to feel that they can do at least one thing very well. Pay attention to what your children like to do. Help them develop those skills, or find out where they can learn more.
• Build thinking skills. One way to help your child build thinking and reasoning skills is to get involved in your child’s school. Volunteer if possible, work on having good relationships with teachers and other staff members, and show your interest in what your child is learning.

Caring about other people
Empathy is an important part of building inner strength. It means that a child can recognize and appreciate how others are feeling. It means that a child cares when others feel bad and that the child wants to help them. You can help your child learn empathy by demonstrating it in your own life and talking with your child about it.

• Volunteering. Do volunteer work. If you can, take your child with you.
• Sharing. Teach your child the importance of sharing.
• Helping. Let your child help you with household chores, and show how happy it makes you to have help.

Helping others can help children learn that they have the power to make others feel better.

Self-control and teaching your child what’s right
• Set limits. Setting limits for your children shows them that you love and care about them. Make sure that your rules are reasonable and that your children understand them. And follow through on any consequences you have established for failing to follow rules.
• Use good discipline techniques. Discipline is the teaching of polite and appropriate behavior. Effective parenting techniques encourage your child’s sense of responsibility, nurture self-esteem, and strengthen your parent–child relationship.
• Teach self-control. Children learn by example. Teach appropriate behavior. Avoid physical punishment for behavior that is not appropriate.
©1997–2019, Healthwise, Incorporated
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What are social connections?

Social connections are the relationships you have with the people around you. They may be close, like family, friends, and coworkers, or more distant, like people you know casually. They can be as close as next door or so far away that you only connect with them by telephone or through the Internet.

Your network of relationships may be big or small. One or two close family members or friends may be all you need to feel supported and valued. Whether your circle is big or small, the important thing is that you are there for each other.

Why are social connections important?

Resilience, the ability to bounce back after stressful situations, is strengthened when you give and receive support. Building positive relationships with people can make a difference in how resilient you are. Try to connect with people who have a positive outlook and can make you laugh and help you. The more positive your relationships are, the better you’ll be able to face life’s challenges.

The support you get from your social connections can add to your feelings of meaning and purpose in life. These, in turn, add to your resilience. Happy, resilient people tend to be more connected to the people around them. Resilient people know that they can depend on the strength of their family and friends when the going gets tough.

Remember that giving support is just as important as getting support. You count on your social connections for support, but they also count on you. Ask others about their families, jobs, and interests, and help them when you can. Don’t always focus on your challenges or talk about yourself. Know when it’s time to listen or just enjoy your friends’ company. Giving support to others builds the social bonds that help make you resilient.

 How can you make more social connections?

There are many ways you can start building positive relationships:

• Invite a friend who makes you laugh, and go to a funny movie.
• Send an encouraging email or text message to someone who’s going through a hard time.
• Look for a faith community that shares your views. It may also have its own organized social groups.
• Call a food bank or hospital and ask about their volunteer programs.You can also connect with people through social media on the Internet. Many people interact more freely with people they can’t see face-to-face. Online forums about specific interests can be a good choice for people who cannot leave their homes or are shy or self-conscious.

©1997–2019, Healthwise, Incorporated

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When the whole family is involved in physical activities together, children learn that being active is fun and makes you feel good. And busy parents can combine family time with exercise time.

Try these tips for getting everyone in the family up and moving together:

Getting started

• As a family, make a list of activities you’d like to do together.
• Make sure the activities are things everyone can do and enjoy.
• Keep a family physical activity log, or hang a calendar on the wall.
• Try to plan one or two family activities a week. For ideas, see the suggestions below.
• Once a month, plan something special that involves being active, like a trip to the zoo, a day hike, or camping.
• Use a safe backpack, stroller, or bike trailer so that smaller children can be included in family activities.

Walking

When family schedules get really busy, going for a walk may be the easiest thing you can do together.

• Start with short walks that everyone in the family can do. Add more distance gradually. Younger children can ride a bike or a tricycle. You can pull a wagon in case little ones get tired.
• Scavenger hunts can keep children from being bored on a walk. Keep in mind a list of “treasures” they can find, such as a red leaf, a blue house, a black dog, or an out-of-state license plate.
• Use a phone app or get pedometers, and work on increasing the number of steps you take on your family walks. Start with a goal of 10,000 steps a day.
• Register the whole family in a family fun run/walk in your community. If the event is for charity, have your family walk through your neighborhood to collect pledges.

Outdoor activities

• Go for a bike ride.
• Join your children in old-fashioned games like hopscotch, tag, jump rope, and hide-and-seek.
• Get involved in family-friendly sports like skiing, skating, swimming, and tennis.
• Play a daily family basketball game in the driveway or at a playground.
• Take up miniature golf or flying-disc golf.
• Fly a kite.
• Pick up trash at a local park.

Indoor and rainy-day activities

• Have a family dance night. Share dances from each generation, and teach each other to do them. Or learn folk dances.
• Create a new dance or exercise routine to a favorite song. Have a different child choose the song each week.
• Go to the mall, and count how many laps you can walk as a family.
• Have a hula hoop contest.
• Set up a fun obstacle course in the basement, garage, or spare room.

General rules

• Limit TV, video games, and computer time.
• Don’t use food as a reward for meeting activity goals.
• Make physical activity a priority. Don’t let things get in the way of family activity time.

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©1997–2019, Healthwise, Incorporated

There’s nothing quite like a good comeback. It’s a testament to the determination of the human spirit, and a reminder of why second chances can be a great thing. The beauty of a comeback is that it happens in many forms. It could be an athlete getting back on the field after a major injury, or a determined older student going back to school to finally earn their degree. For Adam McCullough, it’s finding his way back into the driver’s seat.

For most of his life, Adam, 28, lived without a disability. He grew up in Holmen, WI, and played college football at Macalester College in St. Paul, MN. After graduating, he got a job at the Minnesota Department of Agriculture as a hydrologist, where he’d gather samples of water from lakes and rivers and test what was in them. But on December 26, 2016, Adam was driving home and crashed his car after hitting an icy patch on the road. The accident left him paralyzed from the chest down.

At first, Adam’s main focus was learning how to navigate life in a wheelchair. Simply getting around his parent’s home on his own was a challenge. He set his sights on building strength through physical and occupational therapy, and took part in trial studies for new treatments. Over time, he regained some movement in his hands. As he became more independent, he realized just how much he missed driving.

“Little things pop in your head,” says Adam. “If I want to go to the grocery store by myself, I just don’t have that option. It’s been limiting, you know? I think anyone can picture that.”

Having made so much progress in other areas of his life, he started wondering if there was a way he’d be able to drive again. After talking with his doctor and doing some research, Adam told his TMG IRIS Consultant, Julie, of his new goal. They started this journey by first getting Adam an accessibility assessment to see what he would need to do to drive again. They then got Adam a learner’s permit so that he could practice driving an accessible vehicle. Adam also needed to take a driver assessment to determine the exact equipment he would need in his vehicle so that he could safely and easily drive. Finally, he will have to pass the Division of Motor Vehicles (DMV) road test to get his license.

Through it all, Adam and Julie have worked closely together. They spent time looking into funding options to cover the driving assessment and equipment, and options to purchase a van. Even when the road got long, they knew that together Adam could reach his goal.

“Julie is there every step of the way,” says Adam. “We educated ourselves and researched everything together. Without Julie, I wouldn’t be talking to you [about driving] right now.”

Of course, Julie is quick to say that Adam has been the driving force behind making all of this happen. His grit and persistence to get back to driving and regain independence is amazing, and she says it’s been wonderful to watch him continue to make progress in many different areas of his life.

“Adam has a passion for self-direction,” says Julie. “He’s coming to me saying ‘This is what I need, this is what I want.’”

In January, Adam was finally able to drive for the first time in two years when he test drove accessible vans to figure out which equipment worked best for him. The driving consultant feels confident that, after a few more sessions, Adam will be able to pass the DMV’s road test and get his driver’s license. He says he was thrilled to be driving his dad around for a change.

As Adam gets closer to getting his license, he’s excited for all the possibilities that will open up. Driving his dogs out to the dog park; getting himself to work on his own; visiting far-away friends. However, more than anything else, he’s simply excited to be behind the wheel again.

“When I get the car, I’ll turn the radio volume up all the way and just drive around by myself for an hour,” says Adam. “My dog will have her head out the window. Me just driving around and torturing people with my singing voice!”