On the 10^th anniversary of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), the Association for Behavioral Health and Wellness (ABHW), the national voice for payers that manage behavioral health insurance benefits for over 175 million people, and its member companies today declared continued support for, and further commitment to, creating parity in behavioral health treatment and coverage.

While MHPAEA was signed into law on Oct. 3, 2008, ABHW and its member companies’ efforts to address mental health and substance use disorder (MH/SUD) parity have a much longer history – decades. As an original member and Chair of the Coalition for Fairness in Mental Illness Coverage (Fairness Coalition), we worked with a diverse coalition of stakeholders to win equitable coverage of MH/SUD treatment, and were an avid advocate and supporter of the final bill that became law.

Mental health and substance use disorder parity is a right. Everyone deserves access to equitable, affordable, medically appropriate, high quality mental health and addiction services and treatment. ABHW member companies have diligently worked to drive consistent interpretation and enforcement of MHPAEA across the United States. We will continue our efforts through:

• Improved access to behavioral health treatment, services, and providers;
• Behavioral health co-payments that align with medical visit co-pays;
• Elimination of arbitrary treatment limitations on the number of days of coverage for a condition, as well as financial limits on annual and lifetime dollar caps;
• Adjustments to prior authorization requirements for mental health and substance use disorder services so that they are comparable to medical benefits; and
• Integration of medical, pharmacy, and behavioral health benefits to increase consumer engagement and reduce overall medical costs.

While great strides have been achieved, we acknowledge that more can be done to ensure that mental health and addiction parity is being implemented in the manner in which it was intended.

• Accreditation – Currently there is no parity accreditation standard that would deem a health plan parity compliant. Recognition of such an accreditation by consumers, federal and state governments, employers, and providers would support consistency of interpretation and assessment of parity compliance.
• Best Practice Examples – Additional illustrations from the federal regulatory agencies of health plans that are implementing MHPAEA correctly or states that are accurately enforcing MHPAEA would be very helpful in advancing parity compliance. If regulating agencies release de-identified information related to non-compliance issues it would provide interested parties with a thorough picture of the regulator’s intent related to MHPAEA and would lead to improved compliance.
• Substance Use Disorder – Currently, there is not parity in the way health care professionals access SUD records. This puts SUD patients at greater risk and inhibits integrated care for these individuals. Since SUD patients and their records are siloed from the rest of medicine, many individuals are receiving substandard, uncoordinated care.

ABHW and its member companies are committed to the full implementation and enforcement of the parity law. We will continue our efforts to work with consumers, employers, health plans, state Medicaid agencies, regulators, legislators, providers, behavioral health interest groups, and others to further parity compliance, educate consumers about the law, and provide the tools and resources needed to make informed decisions.

Signed,

Association for Behavioral Health and Wellness

Aetna Behavioral Health

Anthem

Beacon Health Options

Centene Corporation

Cigna

Magellan Health

New Directions Behavioral Health

Optum

PerformCare
ABHW is the leading health plan association working to improve access and quality of care for mental health and substance use disorders. ABHW’s members include national and regional health plans who care for more than 175 million people. Together we work to reduce stigma and advance federal policy on mental health and addiction care. Member companies – Aetna Behavioral Health, Anthem, Beacon Health Options, Centene Corporation, Cigna, Magellan Health, New Directions Behavioral Health, Optum, and PerformCare.

Parity Progress

Ten years ago today, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was passed into law. This ground-breaking legislation required health plans to treat mental health and substance use conditions like physical medical conditions without treatment or financial limitations. For more than 40 years, Magellan has wholeheartedly supported and actively advocated for parity. Every day, we work together with our customers — health plans, employers, state Medicaid and military and government clients — to innovate new solutions on behalf of those we serve, which continues to advance the law and helps to reduce the stigma around mental health and substance use issues. At Magellan, mental health is fundamentally as important as physical wellness, but it’s just a start.

Beyond equal to individualized and integrated

While our country has made positive strides in parity, we know achieving a healthy, vibrant life is tied to many factors beyond parity – namely social determinants, such as housing, poverty, education and access to transportation and healthy food. One way we are addressing and accounting for these social determinants is by focusing on providing individualized, integrated care.

Complete Care-Person-centered. Community-focused. Evidence-based.

A great example is Magellan Complete Care, which operates person-centered health plans that provide complete care coordination for recipients in Medicare and Medicaid. In the state of Florida, we developed the first-in-the-nation Medicaid specialty health plan to integrate physical and behavioral healthcare and address the social determinants of health for individuals living with serious mental illness and substance use disorders. In Arizona, Massachusetts, New York and Virginia, our Medicaid health plans integrate the full continuum of healthcare services – including mental health and substance use disorder services and treatments individualized to help each member live their healthiest, most vibrant life.

Integrated Health Neighborhoods

Magellan Complete Care plan participants include many individuals who contend with complex conditions that impact their physical health and mental well-being every single day. These individuals need to stay connected to their families, friends, neighbors and others in their communities to maintain independence and achieve optimal health and well-being. Doing so makes the difference between surviving and thriving. To these ends, we have pioneered a care coordination model called the Integrated Health Neighborhood (SM).

This model challenges the definition of what you might think a traditional health plan does for its members. Instead of just focusing on physical and behavioral health treatment, Integrated Health Neighborhoods work within existing community support agencies and local public health systems to strengthen and extend their reach. Our local teams help each member navigate these systems and supports based on their needs as well as their preferences for connecting in their own communities. This helps minimize member disruption through the use of familiar local provider networks and support from trusted community organizations.

Our Integrated Health Network teams are comprised of Magellan associates who live in the same communities as the members they serve. Our assigned teams personally know people at agencies, organizations and local resources across their neighborhood, whom they can call on, person to person, to find the right resources for each member. They work collaboratively to help each individual member find his/her path to independence and well-being.

Recovery Support Navigators

A unique part of the team are the Recovery Support Navigators. These are certified peer support specialists who have lived experiences with some of the same challenges our members face – they have experienced substance use disorders or psychiatric disabilities and may have personally been homeless, had their utilities turned off or experienced food insecurity. They can relate to the members they support, empathize, and then draw on real-world solutions to help them.

For the past 20 years, Magellan has been a leader in increasing access to peer support through partnerships with the recovery community and providers.  We have assisted state customers in developing robust certified peer specialist capabilities, driven in large part by our depth and breadth of experience.   We create shared learning opportunities for the peer workforce and others to improve and enhance the knowledge, skills, and competencies of the peer workforce across the continuum.  Our Recovery Support Navigators represent our best practice approach to tapping the power and potential of peer support.

We know people are more than just a diagnosis – or multiple diagnoses. Truly living healthy, vibrant lives means seeing more than parity for the pieces. It’s seeing and caring for the whole person and bringing together the right resources across the community to help. Integration and individualization are the next steps, and I am proud to say Magellan is out front and on the ground in neighborhoods around the country, taking these steps with our partners and members – together!

A child’s mental health affects nearly every aspect of their overall health. Their physical health and their ability to become successful, contributing members of society depends on the state of mind they bring to every situation. Children’s mental health issues are real, common and treatable. An estimated 15 million of our nation’s young people can currently be diagnosed with a mental health disorder. Many more are at risk of developing a disorder due to genetic and environmental risk factors. However, it is estimated that only about 7 percent of youth who need services receive appropriate help from mental health professionals (Department of Health and Human Services, 2001 — Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda).

1) What should I do if I am concerned about mental, behavioral, or emotional symptoms in my child? Keep in mind that every child is different. Even normal development, such as when children develop language, motor, and social skills, varies from child to child. If you are concerned about changes in behavior or other symptoms, talk to your child’s doctor or health care provider. If your child is in school ask the teacher about observed changes in behavior and see if the school system can provide an evaluation. Share this with your provider as well. Be prepared to seek further evaluation by a specialist with experience in child mental health issues. Specialists may include psychiatrists, psychologists, social workers, psychiatric nurses, and behavioral therapists.

2) How do I know if my child’s problems are serious? Many everyday stressors can cause changes in a child’s behavior, however, not every problem is serious. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. Behavior patterns that may indicate a more serious issue include:

• Problems across a variety of settings, such as at school, at home, or with peers
• Changes in appetite or sleep
• Social withdrawal, or fearful behavior toward things your child normally is not afraid of
• Returning to behaviors more common in younger children, such as bed-wetting, for a long time
• Signs of being upset, such as sadness or tearfulness
• Signs of self-destructive behavior, such as head-banging, or a tendency to get hurt often
• Repeated thoughts of death.

3) How are mental illnesses diagnosed in young children? Just like adults, children with mental illness are diagnosed after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose a child themselves, but many will refer to a specialist for diagnosis and treatment.

• Before diagnosing a mental illness, the doctor or specialist tries to rule out other possible causes for a child’s behavior. The doctor will:
• Review the child’s medical history
• Discuss the issues you have observed
• Review the child’s developmental level
• Ask about any family history of mental health disorders
• Ask if the child has experienced physical or psychological traumas, such as a natural disaster, or situations that may cause stress, such as a death in the family
• Consider reports caretakers and/or teachers

Children are constantly changing and growing and diagnosis and treatment must be viewed with this in mind. While some problems are short-lived and don’t need treatment, others are ongoing and may be very serious. In either case, it is important to see more information so you can understand treatment options and make informed decisions.

3) What are the treatment options for children? The specialist will recommend specific treatment based on the diagnosis. Treatment options may include psychotherapy and/or medication. Talk about the options with the specialist and ask questions. Some treatment choices are a part of standard health care practice while others may be in the experimental stage.

4) Will my child get better with time? Some children get better with time and others children may need ongoing professional help, it all depends on the diagnosis. That is why it is important to consult with a health care providers as soon as possible because treatment may produce better results if started early.

5) How can families of children with mental illness get support? Like other serious illnesses, taking care of a child with mental illness is hard on the parents, family, and other caregivers. Support groups are available for many different types of issues and age groups. By sharing experiences in a safe and confidential setting encourages empathy and a sense of community.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: American Psychological Association, National Institute of Mental Health

If you have, or believe you may have, a mental health problem, it can be helpful to talk about it with others. It can be scary to reach out for help, but it’s often the first step to helping you heal, grow, and recover.

Build your support system
Find someone—such as a parent, family member, teacher, faith leader, coworker or healthcare provider who:

• Gives good advice when you want and ask for it
• Assists you in taking action that will help and doesn’t escalate bad feelings
• Likes, respects and trusts you, and who you like, respect and trust, too
• Allows you the space to change, grow, make decisions, and even make mistakes
• Listens to you and shares with you, both the good and bad times
• Respects your need for confidentiality so you can tell him or her anything
• Lets you freely express your feelings and emotions without judging, teasing, or criticizing
• Works with you to figure out what to do the next time a difficult situation comes up
• Has your best interest in mind

Find a peer group
Find a group of people with mental health problems similar to yours who are taking care of the problems in a positive way. Peer support relationships can positively affect individual recovery because:

• People who have common life experiences have a unique ability to help each other based on a shared history and a deep understanding that may go beyond what exists in other relationships
• People offer their experiences, strengths, and hopes to peers, which allows for natural evolution of personal growth, wellness promotion, and recovery
• Peers can be very supportive since they have “been there” and serve as living examples that individuals can and do recover from mental health problems
• Peers also serve as advocates and support others who may experience discrimination and prejudice

You may want to start or join a self-help or peer support group. National organizations across the country have peer support networks and peer advocates. Find an organization that can help you connect with peer groups and other peer support.

Participate in your treatment decisions
It’s also important for you to be educated, informed, and engaged about your own mental health. Get involved in your treatment through shared decision making. Participate fully with your mental health provider and make informed treatment decisions together includes:

• Recognizing a decision needs to be made
• Identifying partners in the process as equals
• Stating options as equal
• Exploring understanding and expectations
• Identifying preferences
• Negotiating options/concordance
• Sharing decisions
• Arranging follow-up to evaluate decision-making outcomes

Develop a recovery plan
Recovery is a process of change where individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Studies show that most people with mental health problems get better, and many recover completely.

You may want to develop a written recovery plan. Recovery plans:

• Enable you to identify goals for achieving wellness
• Specify what you can do to reach those goals
• Can be daily activities as well as longer term goals
• Track your mental health problem
• Identify triggers or other stressful events that can make you feel worse, and help you learn how to manage them

Help is available. For additional information, visit MagellanHealth.com/MYMH

Source: MentalHealth.gov

This blog post is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Should you require specific help or feel that you are in crisis, you should seek the assistance of an appropriately trained professional.

If you have family, friends or colleagues who live with mental illnesses, you may be unsure of how to speak to them in a respectful way. You want to show you care, but don’t know how to express your concern and not hurt the person at the same time.

Just ask…

1. Can you help me understand what it’s like living with your condition?
2. Is there anything you need from me or something I can do to help you?
3. Can we do something together – get coffee, go for a walk or see a movie?
   Just because the person has mental illness doesn’t mean he/she won’t want to do regular activities
4. What is your diagnosis and how do you feel about it?
5. Do you need to talk?
   Sometimes talking can help make things feel a little better.
6.  What can I do to be there for you, and help you feel supported?
7. How can I support you – can I listen to you, leave you alone, give you a hug?
8.  How has living with this condition shaped who you are today?
9. How are you? You don’t seem like yourself, and I want to know how you’re really feeling because I care about you.

Find Help and More Information Regarding Mental Illness

Help is available. For additional information, visit MagellanHealth.com/MYMH.

For more information on treatment resources, contact:
National Institute of Mental Health
https://www.nimh.nih.gov/health/find-help/index.shtml

NAMI (National Alliance on Mental Illness)
http://www.nami.org/

Substance Abuse and Mental Health Services Administration (SAMHSA) https://findtreatment.samhsa.gov/https://www.mentalhealth.gov/

Mental Health.gov
https://www.mentalhealth.gov/
Help is available. For additional information, visit MagellanHealth.com/MYMH

Read more about Mental Illness from Magellan Health Insights

When a person you care about is going through a difficult time or has been out of sorts for an extended period, it’s hard to watch and is only natural to want to do everything you can to help him or her feel better.

While this person may feel very grateful to have your support, there’s really only so much you can do as a friend, family member, or colleague. There comes a point where the person could really benefit from seeing a professional who can provide some unbiased advice and insight.

Treatments for mental illnesses are highly effective. According to the National Library of Medicine, only one out of three people who need help might actually seek it. Of that, the people who need help the most are typically the least likely to get it. People may worry about appearing weak if they seek therapy, or they may not even realize they really are sick.

Approaching the person and encouraging him or her to seek therapy can be a tricky situation. If done the wrong way, you could aggravate the person or turn him or her against the idea entirely. There is an effective way to have this conversation, but keep in mind that each person is unique, and what works for one person with mental illness may not be the solution for every person.

Nine steps to set up the conversation

1. Let the person know that you need to have an important conversation.
2. Pick a good time and a quiet place without other distractions.
3. Approach the person with empathy and consider using a phrase such as “If I didn’t care about you, we wouldn’t be having this talk.”
4. Be prepared for the person to be upset, but try not to get defensive.
5. Use “I” statements such as “I’m concerned about you.”
6. If the person has expressed concerns or frustrations to you, repeat these back to the person.
7. Avoid using words such as “crazy” or “abnormal.”
8. Offer to help in the process of finding a therapist or counseling service and scheduling an appointment.
9. Remind the person that you care about him or her and are here to provide ongoing support.

As a friend, family member, or close colleague, you have a lot of power in helping the mentally ill person that you care about. Use it. Help is available.

For additional information, visit MagellanHealth.com/MYMH

Source: Psych Central

When Magellan Health received word that it had been named a Fortune 500 company for the first time in our company’s history, it was cause not only for great celebration, but also reflection.

In recent years, we’ve experienced tremendous growth and momentum. Our purpose—“Leading humanity to healthy, vibrant lives”—fuels the work of our more than 10,000 associates, who are dedicated each day to making a meaningful difference in members’ health and their lives. One of our biggest growth drivers has been our ability to innovate and introduce new products that resonate and disrupt the industry across all areas of healthcare and pharmaceutical management, with the ultimate goal of delivering a consumer-centric model that improves health and health outcomes.

At Magellan, our model of care is unique in that it is both high-touch and high-tech, supported by an innovative and inclusive culture. Three keys to our success stand out.

When it comes to innovation, Magellan’s secret sauce is its culture. We continually seek people from outside the healthcare industry to challenge the status quo and help drive innovation around access to care and care quality with their unique perspectives. By providing our associates the space, flexibility and resources to experiment, we encourage creativity and offer the freedom to pursue ideas that push traditional boundaries. We put a great deal of trust in our talented colleagues instead of relying on a structure that in and of itself is defeatist for innovation.

We innovate with the member in mind. At Magellan, we’re dedicated to consumer-centric care that achieves improved outcomes by integrating healthcare across physical, behavioral and pharmaceutical services. By pioneering new strategies, we’ve been able to tackle the highest-trend components of healthcare expenditures using agile, clinically based technology and applying advanced analytics to develop next-generation solutions. This approach not only enables highly personalized services to be delivered, but also supports the best possible outcomes in the most cost-effective way for our members.

For example, roughly half of total pharmacy spend is driven by specialty drugs, with half of that specialty spend covered under medical benefits. This portion of specialty spend is typically unmanaged by pharmacy benefit managers and health plans. Magellan has differentiated itself in the specialty drug management space by pioneering innovative strategies focused on improved outcomes and value. We provide high-touch decision support tools that support specialty physicians in ordering complicated drug regimens. These tools help to ensure treatments are being administered at the most clinically appropriate site of service and are appropriately used.

We pursue atypical collaborations. Transforming healthcare requires unique collaborations to fuel new solutions that achieve disruptive change and improve health. A majority of our unique collaborations are in the digital therapeutics space. Two years ago, we partnered with Click Therapeutics to create FDA-approved therapeutic apps for treating common behavioral health conditions such as insomnia, anxiety and depression. One example is an app called ComfortAble^TM, which helps people suffering from chronic pain identify and change unhelpful thinking and behavior and learn new problem-solving techniques. At a time when our nation faces an opioid epidemic, much of which stems from difficulties in managing pain, ComfortAble^TM presents an opportunity to curb the use of pharmaceuticals in pain management.

An Eye Toward Tomorrow’s Healthcare Model

As Magellan has migrated to a culture of innovation, one of our biggest learnings is the need to innovate with a small “i.” We’ve learned over time that the best ideas aren’t always going to be big, bold-stroke, billion-dollar ideas. Ultimately, we’re innovating to help people live better, healthier and more vibrant lives. That’s a purpose all of our associates, from our senior leaders to our interns, not only embrace, but act upon.

At Magellan, all of our initiatives are centered on one objective: to provide highly personalized services that support the best possible outcomes in the most cost-effective way for our members. We will continue to innovate and introduce products that resonate, disrupt the industry and make a meaningful difference in people’s lives.

“Strung out. Looking for the next fix. A full time job that doesn’t pay, but just takes.”

That’s how one of Magellan’s Recovery Support Navigators defined her addiction to opiates. She has since overcome the stranglehold of addiction and is now in long term recovery.  Her experiences, and those of her fellow Recovery Support Navigators, provide the credibility needed to influence their peers who are still struggling with addiction and mental illness that recovery is possible and that desperation does not have to define a life.

An estimated 20.2 million Americans live with a substance use disorder[1]. That’s the population of my home state of Florida. Of that, 2.1 million Americans live with an opioid disorder. Similar to serious mental illnesses, substance use disorders can be difficult to address. Those with the lived experience of walking the path from hopelessness to wellness are experts at engaging individuals with the services and supports that foster the recovery process. Stories of changed lives are not the only proof.

A January 2018 study of our internal recovery support navigation program at Magellan Health found statistically significant improvements for individuals living with substance use and mental health disorders. A key component of the Magellan’s internal peer support program is meeting people where they are. The first engagement with members often happens in an emergency room, inpatient setting, or on the streets. Members then choose where future meet-ups happen. Often, that choice is in the comfort of their own home.  If they are experiencing homelessness, the member chooses a safe place.

The study compared utilization of services six months prior to receiving peer support services and six months following the completion of peer support services. Seventy-five percent of the members in the study had a co-occurring mental health and substance use disorder and 50 percent had a co-occurring substance use disorder, mood disorder and psychotic disorder. The study found that members in Magellan’s internal peer support program cost the health plan significantly less in the six months following completion of the peer support program than members who only had care management or who did not receive any intervention from the health plan. The study also found that six months after completing peer services, peer support decreased emergency room and inpatient hospitalizations.

The role modeling by a peer specialist of a life lived well in recovery is evidence for the individual struggling that there can be long term sustainment of recovery. In addition, the data from this study replicates prior findings that peer support has a lasting impact on the lives of those living with substance use and mental health disorders.

[1] Substance Abuse and Mental Health Services Administration. (2017). Mental and substance use disorders. Retrieved from https://www.samhsa.gov/disorders