The following is an excerpt from the 2018 Magellan Community Impact Report.

Care is core to every service we deliver and everything we do. For Magellan, success is about so much more than profit or prestige. It’s about doing well by doing good. We’re always caring, listening, learning and using our collective insight to make a difference. When we care together, we turn hope into reality.

Caring and sharing our lived experiences

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 care and concern they personally received.

High Fidelity Wraparound is a voluntary planning and care coordination process for children and youth (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 creates steps to help youth stay in their homes, schools and communities.

Through our partnership 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.

The  Wiederspahn  family

When Magellan Care Worker Chassity Wiederspahn’s son began  to struggle behaviorally, mentally  and emotionally in first grade, she knew she needed assistance but was at a loss.  Through High Fidelity Wraparound, she was  able to build a team around her family to guide  them in their search for help. The High Fidelity  Wraparound program allowed them to build a strong  support system and learn the resources available in their  community. It gave them confidence that they could handle  the challenges that might lie ahead. As a graduate of High Fidelity Wraparound, Chassity shares her story with the families and providers  she speaks to on a daily basis.

Many of our Magellan team members have lived these  experiences. which enables them to bring a valuable  set of life skills to their daily jobs each and every day.  As employees, the job is more than just the tasks at hand, we  truly care and offer ourselves as role models of hope and success.

The Campbell family

Magellan’s Kathryn (Kat) Campbell, family support specialist, is the proud mother of four beautiful children, two of whom are adopted from Wyoming’s foster care system. Blending a family was an overwhelming process despite the research and preparation of a therapist team. The crash course in secondary trauma left Kat and her partner reeling.

The family was referred by the local crisis center to High Fidelity Wraparound. The process created a safe space for Kat’s entire family to focus on caring for themselves, and they started to feel the support of those around them who were waiting to help. High Fidelity Wraparound’s empowerment and team building strategy gave the family the skills to run their own team for the high needs their children had, long after the family graduated from the process. Kat now trains and mentors providers who work directly  with families like her own.

The following is an excerpt from the 2018 Magellan Community Impact Report.

Coming together for the win

Nowhere is our value of Win Together more apparent than when you see the smiling faces of our employees working together to help improve the communities we serve. Every year, Magellan employees, located throughout the country, voluntarily organize and participate in Magellan Cares community service activities. Magellan Health and the Magellan Cares Foundation also support our employees’ giving in two ways: paying for time off to volunteer and matching their financial gifts. And when times get tough, we help lift up one another through our eMbrace employee assistance fund. Fully funded by employees through payroll contributions, the eMbrace fund helps employees who are facing a personal financial hardship.

Volunteer Time Off (VTO)

• 2018 volunteer time spent: 17,000
• 2018 volunteer states served: 36
• 2018 volunteer impacted organizations: 560+

Matching Gifts

•  2018 matching funds total dollars: $69,398.77
•  2018 matching funds impacted organizations: 152
•  2018 employee donated matched: $25,416.54

eMbrace

•  2018 total gifts received: : $136,419
•  2018 Total distributions to employees: $144,770
• Total gifts received since 2012: $726,499

The Magellan Cares Foundation also provides grants to nonprofits or nonprofit organizations for initiatives that are aligned with our focus areas. Donations support national or large-scale health access and quality improvement initiatives; efforts that help improve the social supports around a quality healthcare system, such as access to housing, food, clothing or self improvement opportunities, and efforts to support America’s military service members, veterans and wounded warriors.

•  2018 total dollars granted: $560,000
• 2018 total impacted organizations: 130

Having type 2 diabetes can be overwhelming. The good news? While everyone’s treatment plan will be different, there’s a good chance you can manage your type 2 diabetes by making healthy choices. Convinced, but still struggling to work good choices into your real life? Start here for tips on treating type 2 diabetes.

The key to treating type 2 diabetes is to keep blood sugar levels controlled and in your target range.

All of the following help to lower blood sugar:

• Making healthy food choices. Try to manage the amount of carbohydrates you eat by spreading them out over the day.
• Losing weight, if you are overweight
• Getting regular exercise
• Taking medicines, if you need them

It’s also important to:

• See your doctor. Regular checkups are important to monitor your health.
• Test your blood sugar levels. You have a better chance of keeping your blood sugar in your target range if you know what your levels are from day to day.
• Keep high blood pressure and high cholesterol under control. This can help you lower your risk of heart and large blood vessel disease.
• Quit smoking. This can help you reduce your risk of heart disease and stroke.

It seems like a lot to do—especially at first. You might start with one or two changes. Focus on checking your blood sugar regularly and being active more often. Work on other tasks as you can.

It can be hard to accept that you have diabetes. It’s normal to feel sad or angry. You may even feel grief. Talking about your feelings can help. Your doctor or other health professionals can help you cope.

With a little support and guidance, patients with diabetes can live healthy, vibrant lives. Our Live Vibrantly: Diabetes care program helps manage all aspects of diabetes from improving wellness, diet, and exercise to optimizing medication use. To learn more about Live Vibrantly: Diabetes, click here.

©1995–2019, Healthwise, Incorporated

Read the full article here:  https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=hw135189#hw135192

This document 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. Magellan Health does not endorse other resources that may be mentioned here.

Follow your body’s hunger and fullness signals. Smart snacking can help you keep your blood sugar levels stable, especially if you are taking medicine for diabetes.

Try these tips:

• Enjoy eating the right portion. Try using a smaller plate, bowl, or glass while you slowly eat your snack.
• Make healthy choices. Eat a piece of fresh fruit. Or combine that fruit with some protein, such as a small apple and a tablespoon of peanut butter. Or try dipping your fruit in some light yogurt.
• Be prepared. Keep cut-up raw vegetables in your refrigerator. If these are ready to eat, you’re more likely to grab them than something else. Try a low-fat dip on the side.
• Eat nuts. Try a small handful of almonds, walnuts, or pecans. These treats each have less than 15 grams of carbohydrate.
• Choose filling foods that can satisfy your hunger without a lot of calories. Try a hard-boiled egg or an ounce of reduced-fat cheese, such as string cheese.
• Skip high-fat dips. Instead, mix plain yogurt, fat-free mayonnaise, cottage cheese, or fat-free sour cream with a small amount of dry soup mix. Or try a bean dip made with fat-free refried beans, topped with salsa.
• Get more fiber. Put that turkey sandwich on whole wheat bread. Mix wheat germ into yogurt or sprinkle it on salads. Choose whole-grain breads and cereals.
• Try something new. Make a pita pizza with a piece of whole wheat pita bread, tomato sauce, and a sprinkling of reduced-fat cheese. Top with sliced zucchini or mushrooms. Bake until cheese is melted. Enjoy!

And remember:

• Don’t eat out of the bag or box. Take a single serving, and eat from a plate or bowl. It’s easy to eat more than you need or want when the bag is open in front of you.
• Don’t buy snacks that aren’t healthy choices. If unhealthy snacks aren’t around, you won’t eat them.
• Keep an eye on the nutrition facts label, especially in low-fat or fat-free foods. To make up for flavor, sugar and salt is often added when fat is taken out.

With a little support and guidance, patients with diabetes can live healthy, vibrant lives. Our Live Vibrantly: Diabetes care program helps manage all aspects of diabetes from improving wellness, diet, and exercise to optimizing medication use. To learn more about Live Vibrantly: Diabetes, click here.

©1995–2019, Healthwise, Incorporated

Read the full article here:  https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=av2453

This document 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. Magellan Health does not endorse other resources that may be mentioned here.

Wyoming’s High Fidelity Wraparound program continues to show successful outcomes for enrolled youth with complex behavioral health challenges.  Operated by Magellan Healthcare, Inc. through a collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Wyoming’s High Fidelity Wraparound demonstrates that young people are getting more needs met in their own homes and communities.

High Fidelity Wraparound, an evidenced-based non-clinical intensive care coordination program, is a national model designed to bridge gaps for youth where challenges in behavior and mental health exist. The program uses peers and lived experience in a strengths-based way, focusing on what people do well and provides alternative options in addition to therapy and other traditional methods that fit individual preferences and cultures. This team approach provides a network of support for families, allowing them to be the experts of their lives and learn to drive the process.

“When youth behavior is extreme, there is higher probability of needing to leave home or school to address their needs in a clinical, therapeutic or detention setting. We meet people where they are, use assessments like the Child and Adolescent Needs and Strengths (CANS) to identify needs and strengths, which inform the team of behaviors that should be addressed,” said Tammy Cooley, senior director of operations, Magellan Healthcare. “Youth are supported in meeting challenges like staying in school, having more positive relationships, and doing more of the things children should be doing at their age, which ultimately builds confidence and lasting positive change.”

In Wyoming’s High Fidelity Wraparound programs, CANS are administered at the beginning of a youth’s enrollment into the program and every three months until the youth successfully completes the voluntary program and transitions out.

Barbara Dunn, Director of Program Innovation and Outcomes for Magellan of Healthcare in Wyoming, said, “From July 2018 to June 2019, over 75 percent of youth enrolled in Wyoming’s High Fidelity Wraparound program experienced reduced severity of needs. The typical youth enrolls with nine treatment needs and resolves almost four while increasing strengths to maintain their gains.”

 Decreased Needs and Increased Strengths

July 2018-June 2019

Cooley said, “The evidence is powerful and shows reductions in high prevalence needs between a youth’s enrollment and discharge. Our program works when youth and families are engaged. Wyoming’s Department of Health, Division of Healthcare Financing (Medicaid) has given us a chance to deliver a quality home and community-based program through a care management entity model that gives high risk youth more access to care right where they need it most. From the results of this year’s CANS report, we show Wyoming’s High Fidelity Program is making a positive impact in the lives of our youth participants. We want all youth who qualify for this Medicaid program to see the benefits.”

 Wyoming CANS Initial Scores vs. CANS Discharge Scores in Key Intervention Areas

June 2019-July 2019

For more information about Wyoming’s High Fidelity Wraparound program, please visit www.MagellanOfWyoming.com.

About Magellan Health: Magellan Health, Inc., a Fortune 500 company, is a leader in managing the fastest growing, most complex areas of health, including special populations, complete pharmacy benefits and other specialty areas of healthcare. Magellan supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan’s customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators. For more information, visit MagellanHealth.com.

The costs associated with cancer care continue to rise, and many new therapy developments are on the horizon. When looking specifically at medical benefit drug spend, which has historically gone unmanaged, oncology medications make up one-third of total per-member-per-month spend, with an average cost per claim of over $2,300 for commercial plans.¹  With estimates that overall oncology spending will reach $220-$250 billion dollars over the next five years², there is a critical need to provide better management for this spend category.

We asked Rebecca Borgert, Pharm.D., Senior Director of Clinical Oncology Product Development at Magellan Rx Management, for her thoughts on what strategies payers should consider for patient-focused, holistic oncology management.

When it comes to tried-and-true cost containment strategies, like utilization management guidelines, what innovations do you see in the oncology space that are making an impact for payers and their members?

The need to ensure patients are receiving evidence-based cancer treatment continues to be of paramount importance. In the era of precision medicine , treatments are often personalized and based on the patient’s specific genomic profile; payers want to ensure their members are receiving the best treatment for their particular cancer. Due to the extremely high cost of most cancer medications, interventions aimed at unit cost savings can improve value and decrease waste. For example, waste often occurs as part of the drug compounding process due to limited vial size availability. Compendia guidelines endorse rounding doses to within 10% of the calculated dose in order to optimize vial utilization and decrease waste. Additionally, other classes of drugs may be candidates for dose optimization strategies. These increased efficiencies can account for thousands of dollars of savings per dose while decreasing overall waste in healthcare.

While a focus on the patient is critical, there’s also the need to engage providers and provide solutions that allow for cohesive workflow. Enhanced claim edits and appropriate network/fee schedules can also be effective management strategies. At Magellan Rx, we stay up to date on the latest trends and have more than 15 years of experience in providing our customers with flexible interventions, like the ones just discussed, to manage both medical and pharmacy oncology spend. It’s important to understand that a one-size-fits-all approach will not work in today’s dynamic healthcare environment.

In 2018, the U.S. Food and Drug Administration set an all-time record with the highest number of drug approvals in the last 23 years (59 total). Several new medical pharmacy drugs were approved for oncology, including 6 biosimilars. How can payers and providers be better prepared for this evolution and ever-expanding pipeline?  

Unlike the pharmacy benefit where formulary management is an industry standard practice, formulary management under the medical benefit is a relatively underused strategy. The introduction of multiple oncology biosimilars presents a perfect opportunity to execute a medical pharmacy formulary strategy in this space.

Currently there are a number of oncology supportive care biosimilars already in the market and, most recently, we have seen the launch of two oncology therapeutic biosimilars. In late 2019 and early 2020, we anticipate the launch of several more of these FDA-approved oncology biosimilars which will create true competition in the marketplace. While discounts for biosimilars compared to their reference products are in generally only in the range of 10%-15%, due to the high cost of these therapies and their prevalent utilization, it is possible for payers to achieve large cost savings with these agents by adopting a thoughtful biosimilar formulary strategy.

At the center, we have patients and their caregivers who are trying to navigate the complex journey from diagnosis to treatment through survivorship. Is this an area of focus that can have a positive effect on outcomes and mitigate rising oncology spend?

Receiving a diagnosis of cancer often results in a total upheaval of the patient’s life as well as the lives of their family members. Providing patients with consistent support and personalized assistance can help to ensure they are able to be compliant with their prescribed treatment. This also helps patients understand the anticipated side effects of treatment and how to proactively manage those side effects, avoiding the need for unplanned acute care.

1. IQVIA. 30 May 2019. Global Oncology Trend Report 2019. https://www.iqvia.com/insights/the-iqvia-institute/reports/global-oncology-trends-2019. Accessed October 15, 2019.

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.

Primary care providers can be responsible for everything from first line dermatology to behavioral health to musculoskeletal injuries. In a world of rapidly changing technologies, and in which new therapies can cure or alter diseases that only a few years ago would have never been thought possible, the basics still matter. As a clinician, I’ve practiced internal medicine and psychiatry, and still have the opportunity to work with a FQHC in building integrated care. Those experiences and my national view of utilization and prescribing patterns highlight the need for provider support to care for persons with mental health conditions, including opioid use and abuse.

It is often challenging to translate new medical knowledge to the clinic setting. How does a provider care for the individual on a potentially lethal combination of opioids, benzodiazepines, and muscle relaxants? Or, how does one address the young child who has been placed on a combination of psychotropic medications.

In our current health system, primary care providers are in the best place to begin patient care journey or change the course of an already established treatment plan. An effective solution for supporting providers in delivering high quality care is in the form of provider support, especially through programs that involve data analytics, followed by one on one academic detailing. PBMs are in a unique position, having the ability to assist providers in working with patients on complex behavioral health or opioid regimens. PBMs have access to data that allows for identifying outlier member and provider behavior and finding patients who are at risk for adverse outcomes. While PBMs don’t have access to prescription drug monitoring programs, they can see what prescriptions are filled, where there is overlap, and where there are multiple providers interacting with a patient.

Magellan Rx developed the Live Vibrantly: Whole Health program to address those outlier providers and members, with the goal of achieving higher quality care. This program uses evidence-based algorithms to find members who may be at risk for adverse outcomes, and targets prescribers who may be over-prescribing. We become the provider’s go-to source for translating the evidence to the bedside through assistance with difficult issues, such as withdrawing an individual from high dose opioids. Through taking an approach to support providers in delivering high quality care, we’ve been able to truly partner in leading our members to leading more healthy vibrant lives.