It’s hard to comprehend how much the world has changed since the beginning of the COVID-19 pandemic. It has turned our lives upside down in many ways, from school and business closures to quarantines and social isolation. With no clear end in sight, it is not surprising that many people are having difficulty getting used to the “new normal” that is far from what normal life once was.

Families face the challenges of online and home schooling, and the coming school year brings more uncertainty.  In addition, many people are experiencing financial strain from reduced working hours or job losses. Workers may have to work from home and adapt to an entirely new way of working, with little social interaction.  For some workers, juggling parental and domestic duties with the demands of work has been very stressful. Over time, chronic stress can lead to burnout.

Symptoms of burnout include feeling physically depleted, emotionally exhausted and negative about work.[1]

The signs of burnout are similar to those of depression. If left untreated, burnout can lead to physical illness and mental health problems, such as depression and anxiety. Here are some practical tips to manage burnout:

• Set boundaries between work and private life. If you work from home, set clearly defined working hours and a specific work area.
• Take breaks during the day and build transitions in your life between the start of work and the end of the working day. For example, making a transition to work can be as easy as getting a cup of coffee each day and logging into your computer at the same time. To end the day, practice a daily routine such as checking your emails, reviewing priority tasks for the next day and logging off your computer.
• Take your well-earned time off. Even if the pandemic kept you from going somewhere for vacation, a planned “staycation” will allow you to enjoy the well-deserved rest and relaxation. It is important to recharge; you will feel refreshed when you return to work.
• Don’t forget to socialize. When your colleagues start working from home, you may miss the casual social interactions had throughout the day. Like any skill, use it or lose it. Socialization in a time of pandemic takes effort to maintain.
• Make self-care a part of your daily routine. A healthy diet, getting enough sleep and maintaining an exercise schedule can help you cope with and reduce stress.
• Maintain consistent family routines. A regular routine can help all family members feel more focused and productive. If your child is at home learning online either full or part-time or you’re home-schooling, set consistent times for meals, schoolwork, other activities and bedtime.

Help is available. Your program is completely confidential and here to help you and your household members 24/7/365. No situation is too big or too small. Give us a call or visit your program website to get started.

[1] https://www.who.int/mental_health/evidence/burn-out/en/

Technological and scientific advancements have dramatically altered the treatment landscape in several disease states. These include orphan diseases and conditions that previously had no disease-modifying treatment options. These innovative therapies have also come with unprecedented costs, with some agents introduced at a price exceeding one million dollars for a single patient. Value-based purchasing arrangements (VBPs) have attempted to manage the initial cost of these agents. In a VBP, which is sometimes referred to as an outcome-based arrangement, the ultimate price that is paid for the drug is dependent on the clinical outcome. In addition to a plan’s traditional utilization management initiatives to maintain sustainability, this strategy aims to hold pharmaceutical manufacturers responsible for the result of their product. This is similar to other healthcare environments, such as when readmissions impact hospital reimbursement. Under VBPs, a pharmaceutical manufacturer would issue a reimbursement if their product failed to produce the desired clinical outcome. In addition, this strategy incentivizes the development of unique therapies that are more likely to have a clinically significant impact. Novel medications that improve outcomes would provide a greater healthcare value and could be priced higher in the market. Currently, volume is a large driver of cost, with discounts from pharmaceutical manufacturers often tied to the number of units dispensed. This is less helpful for niche-area pharmaceuticals and genuinely innovative treatments used for uncommon conditions.

Practical considerations of VBPs, such as a higher administrative burden (e.g., paperwork, electronic database access, automated retrieval of data), limit their application to all products. Since it can be expensive to measure outcomes in order to assess the worth of a product to an individual patient or plan, VBP concepts are most commonly applied only to the costliest medications. For instance, VBPs can have a significant impact on the pricing of agents like gene therapy or select oncology agents. Some of these agents can have a large clinical impact on disease progression, survival, or quality of life, but a drug may not have the same results in all patients. However, value-based or outcome-based pricing may provide an increased incentive to payers by decreasing their initial risk and providing more sustainable treatment coverage.

While there has been an increase in the use of VBPs by states, manufacturers, and other payers in order to control drug spending and tie patient outcomes to cost, uncertainty remains in developing novel VBPs. The Medicaid Drug Rebate Program (MDRP) created by Congress under the Omnibus Budget Reconciliation Act of 1990 ensures that Medicaid receives the lowest net price for a single source drug or innovator multiple source drug during the rebate period charged to any payer. Simply put, pricing net of all discounts, must be reported to Medicaid, and the best price would have to be offered to Medicaid as well. It is critical that Medicaid programs continue to receive the lowest price available for a single source drug or innovator multiple source drug.

On June 19, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that is aimed at promoting VBP flexibility for a variety of payers, including Medicaid, with a goal of maintaining a best price for Medicaid. CMS notes that best price creates challenges related to the availability of VBP arrangements. For example, under existing best price rules, if an individual fails to achieve the specified clinical outcome under the VBP arrangement, the drug manufacturer may be required to provide a discount or otherwise may not be entitled to payment for that patient. Thus, the best price of that drug for purposes of the MDRP could become zero. This possibility has stunted the development and proliferation of VBPs. This new proposal from CMS, which includes other regulatory revisions as well (e.g., minimum standards for Drug Utilization Review [DUR] programs), could ultimately lower healthcare costs and potentially limit spending on treatments with limited value over time.

The ultimate goal of a VBP is for all parties to have a vested interest in the outcomes of drug therapy and to share the risk related to healthcare costs. Specifically, it calls on manufacturers to have more “skin in the game.” Moreover, the change to the Medicaid market could have potential savings applicable to a variety of market segments, impacting all Americans. Regardless of the final outcome or any changes made to the current draft prior to its possible rollout, the proposal demonstrates readiness from CMS to pivot prior strategies to mitigate rising drug prices.

As our country continues to navigate the coronavirus pandemic and social distancing, a new concern has emerged – avoiding and delaying medical help when necessary, also known as medical distancing. Maintaining physical and mental health during the current pandemic is essential. If you are feeling ill, need a routine medical check-up, or have severe feelings of anxiety or depression, please seek medical attention.

Stop Medical Distancing 

It’s important that you feel safe and get the care that you need, when you need it. Here are some helpful tips to safely receive medical attention while social distancing:

1.  Mask Up– The Centers for Disease Control and Prevention have asked all Americans to wear a cloth face covering to help prevent the spread of the coronavirus. Medical facilities require patients, staff, and providers to wear a mask to protect you and your community. Take part in the fight against the coronavirus by complying and wearing a mask, too.

2.  Distance Yourself– When you are waiting to be seen by your physician, ask if you can wait outside or in your car. If you have to stay inside, do your best to distance yourself from other patients, visitors, and staff. When returning home, avoid being in the presence of those most vulnerable to coronavirus.

3.  Sanitize– Medical facilities are regularly cleaning waiting areas and exam rooms between each patient. Hand washing and sanitizing your hands before and after your visit is a must to protect yourself and your family from getting sick. Keep hand sanitizer in easy-to-reach places so you don’t forget, such as your bag, purse, pocket, or in your car.

4.  Limit Visitors– To create a safe environment, many medical facilities have implemented restrictions and limitations on visitors. This helps protect you and other patients who are vulnerable to the coronavirus. Going to the doctor alone can be scary and intimidating – but it’s essential to limit friends of family members from going with you when it can be avoided.

5.  Go Digital– If you’re still not comfortable with face-to-face visits or don’t need to be physically seen by a doctor, you should optimize telemedicine or telehealth services. These are appropriate and efficient means of connecting with your provider in the comfort of your own home.

6.   Trust– Finally, trust your doctor and know that your safety is their number one priority. As the pandemic continues, medical facilities are adjusting the way they deliver health and enhancing their procedures and protocols.

Protecting yourself from the coronavirus does not need to get in the way of your overall health and well being. #Stopmedicaldistancing

Written by Thomas Lane, NCPS, CRPS

Every 40 seconds someone dies by suicide somewhere in the world.[1] The human tragedy of death by suicide is getting worse, with global suicide rates increasing 60% in the past 45 years.[1] Most people reading this article will know someone who has been impacted by suicide. One group of folks especially at risk for a suicide attempt are those who have tried to complete suicide previously. Data suggests that 20% of attempt survivors will make another attempt.[2]

I am one with personal experience. I am part of that 20%. As a double attempt survivor, I have haunting memories of those periods in my life when I was more fearful of living than I was afraid of dying. For me, those were the darkest, loneliest, and longest days of my life. After my second attempt in the winter of 1998, I wound up on a ventilator. I was in a coma for 12 days and when I woke up, I felt like someone was choking me. And I was angry. At the time, when I was literally regaining consciousness and coming back to the land of the living, my mom was downstairs with hospital administrators signing an agreement to discontinue life support for me.

As the saying goes, timing is everything.

After a lengthy and very shaky period, I began to get better. I was receiving good mental healthcare, redefining my circles of support, and I had a purpose. I came to believe I still had work to do. Now. On this planet. I had twice crossed the line of deciding I could not be here. Despite my best efforts, I was still here, facing my life. I decided I would seek meaning from as many of my experiences as I could. For the past 20-plus years, I have worked to build and advance peer support, particularly within the context of publicly funded healthcare systems, but also at the grassroots level and through public/private partnerships. I am more convinced than ever of the value, importance and unique perspectives folks with lived experience bring to the table, specifically those who choose to pursue careers as peer specialists. It has been and continues to be a transformative movement, even more so when we understand that many folks who make a choice to work in the peer support field, in the same delivery systems that may not have served them well, do so out of a passion for the work and to give back, to pay it forward.

I share this very personal experience as context for my next point.

In a 2016 survey of Magellan members receiving peer support services, 98% reported their certified peer specialist helps them to, both, improve their quality of life, and feel hopeful about their recovery.[3] Knowing what we do now about the effectiveness of peer support, and understanding the value of lived experience, I believe we can agree about the importance of connecting attempt survivors with peer supporters who have had similar experiences. For most, if not all, attempt survivors, there is a crucial time period after an attempt; I needed intensive support in the days following my second attempt. Sadly, intensive support is not always available, let alone offered by a peer who is also an attempt survivor. I can’t help but wonder, what would universal referral to, or at least an orientation about, peer support opportunities by and for attempt survivors, look like? Considering the COVID-19 pandemic, we have seen a rapid, albeit sometimes rocky, migration to technology-enabled service delivery. Interestingly, peer support has been “technology-enabled” for years in the form of peer-operated warmlines. If you’re not familiar with warmlines, check out the National Empowerment Center at https://power2u.org/peer-run-warmlines-resources/ for great information.

When we consider suicide, we know it is all about prevention, that is, preventing people from attempting to take their own lives. I don’t believe there is a higher calling. Many of my peers with the shared experience of being an attempt survivor have expressed to me this is the most important work they do. We see the positive impact of attempt survivors speaking out about their experiences. We see the importance of eliminating shame associated with the topic of suicide. We know suicide is preventable. We understand that prevention requires dialogue, and dialogue isn’t always comfortable. Nonetheless, the topic of suicide must be brought out of the shadows and recognized as the public health crisis it is, one that we can do something about through evidence-based prevention and education practices. We know it does not increase a person’s likelihood of attempting suicide to talk with them about what they’re feeling. Fortunately, there are many, many organizations pledged to this work. From grassroots organizations founded by survivors of suicide loss to nationally recognized organizations, the conversation is changing. We must continue to be intentional in our approach.

National Suicide Prevention Awareness Month helps shine a light on this often misunderstood and taboo topic. Let’s keep the conversation going for the other eleven months of the year. As peers, let’s renew our commitment to offering support, speaking out and holding the hope for someone until they are able to hold it for themselves. As fellow human beings, let’s take inspiration from Emily Dickinson, and tap the eternal hope perched in all of us.

“Hope is the thing with feathers, that perches in the soul

And sings the tune without the words

And never stops…at all.”

For information about Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

[2] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1317-z

[3] Magellan Peer Support Services Outcomes in Pennsylvania, 2016

By Varun Choudhary and Greg Dicharry

The impacts of suicide on population subsets

Suicide is a leading cause of death in the US.[1] It has become the hidden epidemic in our society that is spreading with the COVID-19 pandemic. Statistics show certain populations are more vulnerable than others. While a recent study shows that 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%), Hispanic people (19%), Black people (15%), unpaid caregivers for adults (31%) and essential workers (22%).[2]

Medical professionals have historically been at higher risk for suicide than those in most other professions.[3] Over 400 physicians a year commit suicide, yet the cause for such tragedy is not addressed.[4] A recent example was the suicide of Dr. Lorna Breen, the 49-year-old medical director of an emergency department in New York, who felt like she was drowning amid trying to save lives during the COVID pandemic. She had no history of mental illness and was considered an exemplary physician before succumbing to trauma of witnessing so much death.

Suicide has also been a silent killer within our military for several years, as troops dealing with trauma are unable to get the care they need. This was the case with the recent suicide of 34-year-old Master Sergeant Andrew Christian Marckesano, who had served six full tours in Afghanistan and was nicknamed the real “Captain America.” We must take a proactive approach to suicide prevention so we can help these heroes before they become tragic statistics.

Magellan’s approach to suicide prevention

Magellan is a national leader in suicide prevention and is addressing this health crisis that is devastating so many individuals, families and communities. We believe the first and foremost action that must be taken is to destigmatize the need to ask for help. There is still an ingrained culture in medicine and the military, as examples, that it is a weakness to address mental health needs. We need to build a culture of acceptance and promote the concept that reaching out is a strength, not a weakness. Changing this paradigm will take the effort of many mental health agencies and organizations.

Magellan is here to lead the initiative and use our expertise to bring awareness and training through a preventive model that pushes a zero-suicide approach. We were very successful in launching this campaign in Maricopa County, Arizona, and received international recognition for its effectiveness in reducing suicide. We are working with other organizations to promote this approach, so communities are aware of the signs and warnings of potential suicide, know how to engage suicidal individuals and are able to address the acute mental health needs of these individuals before they escalate.

In recent years, we have had the privilege of hosting a series of suicide prevention summits in Pennsylvania, Florida and Idaho. These events have brought together over 1,000 local and national leaders to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. In addition to this work, Magellan regularly supports local suicide prevention efforts in communities we serve, including sponsoring and participating in annual American Foundation for Suicide Prevention (AFSP) Out of the Darkness Walks around the country.

The Hope Rising for Suicide Prevention virtual summit, September 26, 2020

Most recently, we have established an internal suicide prevention innovations team to develop and implement a plan to enhance our suicide prevention efforts to create more awareness, training opportunities and support for our employees, members, providers, customers and the communities we serve.

Magellan is officially launching the initiative this month for National Suicide Prevention Awareness Month with the Hope Rising for Suicide Prevention virtual summit. This event is being planned and hosted in partnership with the nation’s leading suicide prevention organizations, including the National Suicide Prevention Lifeline, LivingWorks, American Association of Suicidology, Zero Suicide Institute, and numerous other national and international suicide prevention and mental wellness experts, lived experience advocates and people new to suicide prevention to share inspiration, information, wellness techniques and best practices.

This uplifting virtual event will empower attendees with the motivation, skills and resources needed to positively impact suicide prevention efforts in their communities.

Hope Rising for Suicide Prevention is just the beginning, as Magellan continues to create and support impactful suicide prevention initiatives that will help people find the hope and help they need to stay alive and thrive.

For more information about this and other Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.cdc.gov/vitalsigns/suicide/

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.

[3] https://www.healthline.com/health/mental-health/healthcare-workers-suicide-covid-19#3

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526882/

There are an estimated 1.2 million people in the US living with HIV, and roughly 1 in 8 people are undiagnosed. The virus attacks your body’s immune system and weakens its ability to fight infections. When HIV is untreated, it can lead to acquired immunodeficiency syndrome (AIDS), and the body becomes even more at risk for opportunistic infections.

While antiretroviral therapy has been available to treat HIV-positive patients for some time now, certain antiretroviral medications are also FDA-approved to be taken daily to prevent the risk of becoming infected with HIV. This treatment, known as pre-exposure prophylaxis (PrEP), is intended for people who do not currently have HIV but are at risk for contracting HIV. Overall, PrEP has shown to reduce the risk of contracting HIV through sexual contact and injecting drugs by 99% and 74%.

The main goal of any PrEP treatment is to prevent the transmission of HIV to an uninfected person. There are multiple treatments available to help reduce the risk. Regardless of which medication a patient takes, these medications must be taken consistently every day as prescribed. It is also crucial to not skip or miss doses. Possible side effects from PrEP medications primarily include nausea, but in general, these medications are well-tolerated. Despite this, it is still important to tell a healthcare provider about any side effects experienced.

Advances in antiretroviral treatments have made it possible for patients to live healthy, vibrant lives. That said, patient management programs are very valuable to patients whose ability to take their medications as prescribed has direct impact on the long-term success of their treatment.

Stress and anxiety caused by the coronavirus pandemic pose a serious challenge for all age groups. A survey published by the American Psychiatric Association in March 2020 showed that more than one-third of Americans (36%) feel that the coronavirus pandemic is having a serious impact on their mental health. Most Americans (59%) report serious impacts on their daily lives.¹ Calls to crisis hotlines have increased exponentially. In recent studies, adults aged 18 to 44 report emotional and mental health problems associated with the pandemic.

Given that mental-health problems among young adults were on the rise even before the pandemic began, some experts believe that the country is on the verge of a mental-health crisis. Worse, quarantine and closures of medical practices have, in many cases, made access to personal treatment difficult or impossible. Fortunately, state and federal regulations have enabled the expansion of telemedicine services, including treatment for mental illness. Virtual therapies may well be the answer to the needs of millions of people in the mental-health field.

Proven efficacy

Research shows that online treatments can have positive results for a range of mental health problems, including depression, panic disorders, PTSD, eating disorders, anxiety disorders and substance use disorders. Telephone and video-based psychological care and evidence-based treatments such as online cognitive behavioral therapy (CBT) have proven to be as effective as face-to-face therapy.²

The benefits for patients go beyond making treatment more accessible. Virtual therapy offers convenient modalities including live chats, text messaging, video and telephone sessions. Appointments are easy to schedule at convenient times. Virtual therapy is an attractive alternative for people with transportation problems or time constraints. People who are worried about being seen in a therapist’s practice, and those who are reluctant to use traditional mental health services may benefit from increased privacy. In many cases, virtual therapy sessions are more affordable than face-to-face sessions.

Best practices

It is important that therapists have the clinical expertise, licenses and qualifications to virtually treat patients. Reliable technology and secure platforms to ensure customer confidentiality are also crucial. Virtual therapy can solve many mental health problems. However, it is not suitable for patients who are suicidal, psychotic, severely mentally ill or have other illnesses that call for in-person care.

Due to the pandemic, health care is developing rapidly. Magellan Healthcare recognizes the need for additional telemedicine options and is now offering BetterHelp, the world’s largest online counseling service, to help Employee Assistance Program members access convenient therapy options quickly and easily. Click here to learn more about how Magellan is helping our members their mental health, emotional well-being and quality of life.

[1] Psychiatry.org. 2020. New Poll: COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially For Loved Ones; Older Adults Are Less Anxious. [online] Available at: <https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious> [Accessed 13 July 2020].

2 Gratzer, D. and Khalid-Khan, F., 2020. Internet-Delivered Cognitive Behavioural Therapy In The Treatment Of Psychiatric Illness

This month, we are sharing thoughts and insights on the importance of peer support services in healthcare, as well as other systems where peer supporters can be integrated. As the impact of the COVID-19 pandemic continues to be felt across the U.S. and around the world and folks struggle with the fallout, we are seeing an increased need for mental health and substance use disorder services and supports.

COVID-19 mental health impacts  

For many, the virus has taken a terrible toll. Family and friends have been lost. Millions of jobs have been lost. Our collective and individual sense of what is “normal” has been lost.

In a May 14, 2020 news release, the United Nations called for a substantial investment in mental health services to avoid a “massive increase in mental health conditions in the coming months.”

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said this:

“It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic. This is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

Focus on prevention

Public health experts, media and a growing number of policy makers are urgently emphasizing the critical necessity to take a preventive approach to this crisis, urging people to wear masks in public, practice physical distancing and increase testing. If we don’t embrace prevention, we will not beat this disease.

It’s not just infectious diseases like COVID-19 that require a robust, full court press preventive public health response. We need to get serious about prevention in mental health. A 2015 research article, Preventing Mental Illness: Closing the Evidence-Practice Gap Through Workforce and Service Planning stated:

Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in policy dialogue and service delivery, the prevention of mental illness remains a neglected area.

Note the reference to “evidence-practice gap” in the article title. What does that mean? Here’s a great, succinct description from a 2014 article published in PLOS Medicine.

Health research promises societal benefit by making better health possible. However, there has always been a gap between research findings (what is known) and health care practice (what is done), described as the “evidence-practice” or “know-do” gap.

Peer support contributions

So, what are the implications to the peer support workforce I mentioned at the beginning of this article? How does prevention apply to this discussion? Why is there still an “evidence-practice” gap with regard to peer support?

There are 200+ articles published in the literature on peer support. Peer support has long been recognized as an evidence-based practice. In fact, there are several peer-developed, peer-delivered models grounded firmly in the principles of recovery and resiliency, choice and self-determination, and an understanding of a holistic approach to wellness. And these models have been shown to have a positive impact on traditional outcomes, predominantly measured in behavioral health, including significant reductions in hospital admissions, fewer re-admissions and decreased spending on high-cost, restrictive settings like psychiatric inpatient. While peer support is not a clinical service, it has been shown to impact clinical outcomes. Beyond this, folks receiving peer support services express very high degrees of satisfaction with those services and report improved quality of life.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July newsletter. To read the full article, go here.