In 1989, one survey of the general public found that more than half of respondents believed lack of discipline was a possible cause of mental illness. The survey found that, at that time, Americans were more likely to receive information about mental illness from mass media than from medical providers or psychologists. Thirty years later, with the availability of information on the internet, the public should theoretically have a more accurate and balanced perspective of mental illness. But is the public obtaining their information from science-based sources? While there is still much to learn about mental illness, scientists have identified several factors that can play a role in mental health, including genetics, environmental exposure, altered brain chemistry, significant stress, and comorbid medical conditions. With the availability of misinformation on the internet and on social media websites in particular, are we really any better educated on mental health than we were 30 years ago?

The National Institute of Mental Health (NIMH) reports that approximately 1 in 5 adults experiences mental illness annually, with approximately 1 in 25 experiencing mental illness that substantially interferes with or limits 1 or more major life activities. Based on data from the 2018 National Survey on Drug Use and Health, approximately 19% have an anxiety disorder, 2.8% live with bipolar disorder, and fewer than 1% have schizophrenia in the United States (US) adult population. In addition, 7.2% of adults have experienced at least 1 major depressive episode in the last year. Unfortunately, only about 43.3% of adults with a mental health condition received mental health services within the past year, and of those with a serious mental illness, only 64.1% received mental health services within the past year. Even the indirect costs of mental health have a significant impact. Serious mental illnesses have been estimated to cost over $193.2 billion in lost earnings per year in the US, and mental illness has been predicted to cost the global economy $16 trillion by 2030.

Much has changed in the treatment of mental illnesses in the past 30 years. Key treatments for depression, such as selective serotonin reuptake inhibitors (SSRIs) and newer serotonin-norepinephrine reuptake inhibitors (SNRIs), have mitigated some of the limitations of earlier antidepressants (e.g., drug-food interactions or select adverse effects). Even in the past year, novel approvals for treatment-resistant depression (TRD) and postpartum depression (PPD) have emerged. For those with schizophrenia, the availability of newer generation antipsychotics has significantly altered care as well. Although testing for genetic alterations to better identify the best medication choice for a patient is in its relative infancy, the role of pharmacogenomics is rapidly expanding, too. These advances offer promise for individuals with mental illness, but no medication is without risks, and a discussion with a licensed medical provider is essential to establish an appropriate treatment regimen. In addition to medications, the role of nonpharmacologic treatment has expanded in the past 30 years as well, with additional treatment modalities beyond the advancements in psychotherapy alone (e.g., modern cognitive behavioral therapy, interpersonal therapy). A more holistic approach, incorporating lifestyle changes (e.g., diet, exercise) and non-traditional medicine (e.g., meditation, acupuncture), is also gaining in popularity; however, it is critical to understand that herbal or “natural” treatments can have adverse or toxic effects and drug interactions. These should only be used in consultation with a healthcare provider.

Mental illness can contribute to the risks for suicide. Unfortunately, the Centers for Disease Control and Prevention (CDC) reports that suicide rates have increased by approximately 30% from 1999 to 2016. Notably, suicide is rarely caused by a single factor, and the National Alliance on Mental Illness (NAMI) reports that approximately 54% of those who die by suicide do not have a diagnosed mental health condition. Regardless, this leaves a significant portion of patients with known mental health conditions where intervention may have been helpful. Moreover, NAMI also reports that approximately 90% of those who die by suicide show symptoms of a mental health condition. The CDC includes several warning signs on their website and offers advice to several groups ranging from laypersons to the government to healthcare providers. One component the CDC emphasizes to healthcare systems is the need for affordable and effective mental and physical healthcare where people live. In addition, the Zero Suicide Institute provides a framework for continuous quality improvement in health and behavioral healthcare systems aiming to prevent suicide.

Of late, the public seems particularly concerned with the risk of violence in those with a mental illness. A 2006 survey found that 32% and 60% of Americans thought people with depression and schizophrenia, respectively, were likely to act violently toward someone else; however, research has demonstrated that there are several factors that contribute to violence, and that when accounting for these additional factors, the presence of a mental illness is only a modest contributor (at best) to violence. According to the 2018 National Survey on Drug Use and Health, approximately 19.4% of those over 12 years of age have used an illicit drug in the past year and 3% had at least 1 illicit drug use disorder. Additionally, 3.7% of adults reported dual diagnosis (both any mental illness and substance use disorder). Studies of patients with substance abuse or dual diagnosis have found higher correlations with violence compared to mental illness alone. Most importantly, adequate treatment has demonstrated improved outcomes.

With the discussion of mental health in the press and the plethora of inaccurate information on mental health online, it is difficult for the public to develop a truthful foundation on mental illness. While public access to information and scientific discovery have advanced in the past 30 years, the most critical component for the proper diagnosis, effective treatment, and safety of those with mental illness remains consultation with a healthcare provider and/or team.

If you or someone you know may be at risk for suicide, contact the free and confidential Suicide Prevention Lifeline at 1-800-273-TALK (8255). It is available to anyone 24 hours a day, 7 days a week.

Children with attention deficit hyperactivity disorder (ADHD) may have difficulty in school, because their symptoms—inattention, impulsiveness, and hyperactivity—get in the way of learning.

Success in school is important for the development of healthy self-esteem and confidence.

You can help your child succeed in school by:

• Working with teachers and other school personnel.
• Educating yourself about ADHD.
• Helping your child control his or her symptoms.

How can you help your child be successful in school?

You can help your child have the greatest chance of success in school by educating yourself, building relationships, maintaining open communication, working with your child, and keeping good records. Preschool or kindergarten is the best time to start using these techniques. But it is never too late to help a child improve his or her school performance.

Education                                                          

Learning as much as you can about ADHD and your child’s education rights will help you work with the school system more effectively.

• Learn about ADHD. Use the Internet to locate national organizations, ask your doctor, or visit your local library or bookstore for information about ADHD.
• Know your child’s symptoms and treatment plan. Talk with your doctor about your child’s behaviors that may interfere with learning and about ways to control those behaviors. Develop a record of your child’s treatment plan.
• Learn about your child’s education rights. Laws exist ensuring education rights for children who have conditions that interfere with learning. These laws also stipulate that parents have a right to be informed about and participate in educational decisions concerning their child. Contact your state and local education departments for information about ADHD in the schools and your rights to educational accommodations.
• Talk with other parents of children with ADHD. Join a support group for ADHD families. Find out how others have effectively worked with school systems.

 Build relationships

A positive relationship with teachers and other school personnel will improve your child’s chances of being successful in school.

• Start early. Before a school year begins, get to know the principal and other appropriate school personnel. Find out as much as you can about the school policies and rules, especially how behavior problems are handled. Find out if there are other children with ADHD in the school and how their behavior is being handled in the classroom.
• Share what you have learned. Find out if the teachers and other personnel need information about ADHD. Look for ways to help them get that information, such as suggesting books, pamphlets, or any local educational programs.
• Get to know your child’s teacher. Before the school year begins, talk with your child’s teacher about his or her style of teaching and discipline in the classroom. Find out whether the teacher has experience teaching children who have ADHD. Share with the teacher information about your child’s symptoms and what behaviors may interfere with his or her ability to learn. You may want to share your child’s treatment plan with the teacher.
• Make a school plan. Work with the teacher to design a plan to help your child perform to his or her potential. Address how to minimize misbehavior and how to react to it. Your plan will change as your child grows and develops. You may need to work with the school to develop an individual education plan (IEP) for your child. An IEP is a tool for classroom and homework adaptations for a child with a disability. For children with milder symptoms, the school may suggest a plan that is used for medical conditions that do not meet the IEP standards (called a 504 plan).
• Ask school personnel for help when needed. Tutoring or services that help with study or organizational skills are sometimes provided through the school. If not, school personnel often have a list of local resources that can help your child.

Keep communication open

Open communication with your child’s teacher can help resolve problems that may occur throughout the school year. The following are suggestions for working and communicating with your child’s teacher:

• Understand the demands upon your child’s teacher. Most children with ADHD can be taught in a regular classroom, although adjustments are sometimes needed. Not all teachers are trained to do this. Also, teachers are stretched to their limits by large numbers of children in the classroom, making it difficult to give each child personal attention. Ask the teacher what he or she needs from you to help assimilate your child.
• Keep the teacher informed. Share with the teacher any relevant changes in your child’s treatment plan. Help facilitate the sharing of information among you, your child’s teacher, and your child’s doctor.
• Visit the classroom. If possible, volunteer for school activities and parties. This will let the teacher know that you are interested in your child’s education and willing to help.
• Request progress reports. Children with ADHD often lose or forget their assignments. Ask the teacher to complete regular progress reports of your child’s performance and behavior.
• Have a final conference. Meet with the teacher at the end of the school year to discuss your child’s overall progress and the teacher’s suggestions for the next year. Ask him or her about possible teachers for the next year and how to help your child get the best chance for success in school.

Work with your child

• Use treatment methods as recommended by your child’s doctor. This may include medicine and/or behavior management techniques. This will help your child control symptoms of ADHD at home and school.
• Keep your child involved. Let your child know that you support his or her teacher. Clearly outline your expectations and the consequences of misbehavior. Talk with your child about how the teacher will let him or her know that a behavior is becoming inappropriate.
• Link school and home. Use the same signals (such as hand signals) that the teacher uses at school to indicate when a behavior is becoming inappropriate. Also, you can reward your child with privileges for remembering to bring home school progress reports. You can further reward him or her if the report is positive. If your child fails to bring a progress report home, you may treat it as if he or she had an unsatisfactory report and withhold a privilege.
• Help your child organize. Even young children can learn to use lists, daily planners, or calendars to keep up with homework assignments, tests, and activities. A young child may need a teacher’s help in writing down assignments.
• Use learning aids, such as tape recorders or computers. Teach your child how to take notes and to underline important information. If your child seems to learn best visually, ask about books that have helpful pictures and diagrams or workbooks.
• Have short sessions. Keep homework sessions to no more than 20 minutes without a break.

Keep good records

Health and school records can help monitor your child’s academic and behavioral progress as well as help identify when treatment adjustments are needed. You should keep and update the following records:

• ADHD evaluations. Collect copies of any records that are used to evaluate your child for ADHD. These records often identify the type of ADHD that your child has, which helps with treatment.
• Evaluations for any other conditions with similar symptoms.
• History of medicines. Record all medicines that your child has taken or is taking to treat ADHD.
• School progress records. Keep copies of any school plans, daily school progress reports, and formal progress reports throughout the year. Also, keep your child’s final grades and any achievement test results. You may find them helpful as you develop school plans for the following year.
• Individual education plan. If your school developed an individual education plan (IEP) for your child, ask for a copy. You may need to share that information with the health professionals working with your child.

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Children who are socially withdrawn, shy, and appear to lack self-esteem are more likely than other children to be targets for bullying. Children who appear confident and strong are better able to discourage children from harassing them.

Parents and other important adults in a child’s life can use these suggestions to help boost a child’s self-esteem:

• Encourage your child to participate in extracurricular activities such as sports or drama, which can raise a child’s confidence and sense of mastery. Sports, in particular, also help build strength, which can level the imbalance of physical power between children. Some children may prefer individual sports (such as karate, gymnastics, and swimming) over group sports (such as soccer or baseball). Drama classes can help children project strength and confidence, even if they don’t feel it at first.
• Help children become involved socially with other children through school, church, or community activities. This way, children will build social skills and learn to be at ease with others. Children who have friends and “hang out” with them at school are less likely to be targets for bullying than lonely children who have no social support.
• Role-play with children to show them how to appear confident and how to handle encounters with children who harass them. Help children learn to look people in the eye and to speak with a strong voice—but not shout—when talking to would-be bullies.

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“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!

More than 400 nationally-recognized payers, physicians, and industry insiders came together to share thoughts and insights on the ever-evolving specialty drug landscape at the 16^th annual 2019 Magellan Rx Management Specialty Summit hosted August 26-28 in New York City.

As the specialty drug trend continues to rise (especially on the medical benefit) and the pipeline continues to expand, focusing on management strategies and solutions is key. With biosimilars flooding the market and capturing the headlines, and looming policy updates creating uncertainty, this year’s event was a platform to tackle these critical topics and the future of our industry.

“We’re honored to be the forum that brings people together to share insights, engage in thoughtful debate, so that we can all walk away with actionable solutions to effectively manage this growing specialty drug trend.” –Steve Cutts, senior vice president & general manager, specialty, Magellan Rx Management

Highlights from this year’s program include:

• Dr. Peter Bach of the Memorial Sloan Kettering Cancer Center reviewed the latest developments for better oncology management and Dr. Rafael Fonseca, a Mayo Clinic Distinguished Investigator, examined applications for a more personalized approach to treatment for complex specialty conditions.
• Magellan Rx chief medical officer Dr. Caroline Carney was joined by Sarah K. Emond, executive vice president and chief operating officer of the Institute for Clinical and Economic Review (ICER), in a fireside chat about ICER’s approach to health policy and excellence in the U.S.
• Mostafa Kamal, CEO of Magellan Rx, led a panel of forward-thinking innovators who are disrupting the status quo by providing tech-based solutions to improve healthcare delivery and outcomes: Raj Agarwal, chief executive officer at Medocity; Adam Hanina, chief executive officer at AiCure; and Richard Waithe, president of VUCA Health.
• Several panel discussions highlighted next-level management strategies around medical pharmacy solutions as well as emerging therapies like CAR-T and other gene therapies to treat rare and orphan diseases, and featured a diverse group of speakers including executives from national and regional payers, pharmaceutical manufacturers, and physicians:
  • Martin Burruano, RPh, Vice President, Pharmacy Services, Independent Health
  • Mona Chitre, PharmD, CGP, Chief Pharmacy Officer & Vice President Clinical Analytics, Strategy & Innovation, Excellus BlueCross BlueShield
  • Kim Dornbrook-Lavender, PharmD, BCPS, Director, Clinical Pharmacy, Medica
  • Pat Gill, RPh, Director of Pharmacy Programs, Horizon BCBCS of NJ
  • Doug Long, Vice President, Industry Relations, IQVIA
  • Joseph Nolan, General Manager – US, AveXis, Inc.
  • Helio Pedro, MD, Clinical Geneticist, Hackensack Meridian Health
  • Carly Rodriguez, PharmD, Pharmacy Director, Clinical Innovation, Moda Health
  • Natalie Tate, PharmD, MBA, BCPS, Vice President, Pharmacy Management, BlueCross BlueShield Tennessee
• Industry experts Claire Wulf Winiarek, Beth Hebert-Silvia (VP & Practice Lead, Health Plans at Pharmaceutical Strategies Group) and Michael McCaughan (founding member of Prevision Policy LLC) shared their insights on the current policy landscape.
• TV personality and author Janice Dean graced the audience with her very own patient story—after receiving a Multiple Sclerosis diagnosis in 2005, she underwent treatment and found hope and a passion for sharing her story to encourage others who are living with MS to live their best lives as well.
• Keynote speaker Keller Rinaudo shared his incredible story of perseverance that led to the launch of a revolutionary healthcare startup, Zipline, that is rapidly changing the face of medicine in remote parts of the world—and future expansion for U.S. disruption.

As pioneers in specialty pharmacy management since 2005, Magellan Rx has been leading the conversation around better management strategies that not only provide cost savings for payers but positively impact patient health outcomes. Each year, we develop the Specialty Summit agenda with those values in mind. Mark your calendars and join us next year in NYC on August 24-26, 2020 as we host another event that will ignite inspiration and innovation across the industry.

Magellan Health Insights: Dr. Ghani, thank you for chatting with us today. Why do you think it’s important to be aware of minority mental health?

 Dr. Shareh Ghani: Many psychological conditions have a connection to the individual’s perception of themselves. How comfortable do we feel in our environment? How well do we fit into what is seen as the norm? It’s human nature to want to fit in. Being a minority myself as an immigrant to the U.S. from Pakistan, I can see that there is extra pressure when you may be uncertain about fitting in or what is expected.

Seeking treatment for mental health unfortunately carries a degree of stigma for everyone and minorities are much less likely to seek or receive treatment for mental health conditions. For those who don’t speak the primary language or do not speak fluently, it can be even more difficult to seek these services and treatment. In addition, there may not be bilingual providers available or covered in the network, if the patient has insurance coverage – which is less likely for minority members. We are starting to see improvements, but for immigrants and members of other minority groups, it can be even more difficult to ask for help.

Magellan Health Insights: Why wouldn’t a minority member seek out care for mental health?

 Dr. Shareh Ghani: There are many reasons. Fundamentally, these members are often challenged by the complications of poverty and social determinants of health (SDOH). Language, i.e. communication and or comprehension, can be a barrier. Beyond language, it may not be culturally acceptable to ask for help. It may seem embarrassing. Which leads us to stigma. The person’s community at large, the clinicians and physicians providing care, and even the patients themselves may see it as stigma. People openly discuss their diabetes but not their depression.

 In addition, these patients are less likely to be routinely screened. They also may not be able to specify that their symptoms are symptoms of a behavioral health condition. In the U.S., patients come to me and say they think they may be depressed. In India, my patients would describe physical symptoms – like gastrointestinal problems. This means they may go through a battery of tests to eliminate physical diseases before behavioral health is addressed.

Magellan Health Insights: How can providers best support minority mental health?

Dr. Shareh Ghani: Paying extra attention and being aware of the cultural needs of every individual is key. In order to come up with a successful treatment plan, providers need to be knowledgeable about cultural factors. And they need to ask about what their patients preferences are related to care. Unless and until we talk to each person about their comfort level working with a provider of a particular gender, someone from their own culture or sexual orientation, or even age group, we can’t provide the best treatment. We, as patients, are most likely to speak openly when we feel comfortable. Being able to speak openly with a therapist or provider will make it more likely that the member will be accurately diagnosed and that treatment will be more successful.

Providing culturally competent care is critical – all care must be culturally competent care. What does that mean? We must be able to provide care to patients with diverse values, beliefs and behaviors and meet patients’ social, cultural and linguistic needs. We must acknowledge the importance of culture, recognize the potential impact of cultural differences, and adapt services to meet culturally unique needs. By taking training and educating ourselves on cultural competence we can reduce the racial and ethnic disparities in healthcare and give all of our members the best care. 

Magellan Health Insights: We couldn’t agree more! Thank you, Dr. Ghani!

Read more about Minority Mental Health Here

With the number of opioid-related overdose deaths in the U.S. reaching a record high last year, it’s time for our nation to fully embrace evidence-based treatment options that best support our communities, loved ones, friends and families in their recovery efforts.

One growing approach—often considered as the gold standard of treatment—is medication-assisted treatment (MAT). MAT is the use of FDA-approved medications in combination with counseling and behavioral therapies to provide a holistic, person-centered approach to the treatment of substance use disorders (SUDs). The use of this treatment approach has grown to nearly 40 percent in residential facilities and is increasingly leveraged by primary care providers nationwide—but more still must be done for widespread adoption.

The most pervasive stigma surrounding MAT is that it merely enables patients to replace one addiction with another. It’s a belief held not only by some groups of doctors and clinicians, but also family members and peer support groups—those whose support is critical to successful recovery. When a patient’s core support system of family members and peers doubts the legitimacy of an evidence-based form of treatment, the likelihood that the patient will follow through long-term is diminished.

Pair that with a lack of understanding and comfort from the medical community around how to administer MAT, limited numbers of physicians who are certified to prescribe this treatment that actually do prescribe the treatment, as well as the number of residential facilities that offer MAT, and we get low adoption rates as a result of these barriers.

There’s a better way to treat opioid use disorder

Although abstinence-based therapy works for a small percentage of those suffering from OUD, MAT offers a successful way for people to fight their addictions in an outpatient environment, in the community in which they live, and avoid hospitalization or institutionalization. It helps those struggling with OUD and other SUDs address underlying conditions that may have contributed to substance abuse—significantly improving the chances of recovery. In one study, more than half of patients utilizing MAT reported opioid abstinence 18 months after beginning treatment.

Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction. And even fewer actually prescribe buprenorphine to patients. MAT prescribing is not limited to psychiatrists. In fact, primary care providers provide more access to MAT than any other type of provider.

The impact of limited access to MAT on health outcomes cannot be overlooked. One analysis found only one-third of individuals who experienced a nonfatal opioid overdose received access to MAT. Those who received methadone were linked to a 59 percent decrease in mortality rates after one year, according to the analysis. Additionally, individuals who were treated with buprenorphine were associated with a 38 percent decrease in mortality after a year.

Increasing Access to MAT

The SUPPORT for Patients and Communities Act, signed in October 2018, expands the ability to prescribe MAT by increasing clinician eligibility for certification. This provision is a solid and necessary step toward broadening access to treatment; however to make a true impact on the opioid epidemic, we must break the stigma surrounding MAT.

When it comes to recovery, the potential for relapse is high, especially in the early stages when resolve is fragile. It is important to note that for individuals with co-occurring mental health conditions, chronic pain or other addictions, MAT should be supplemented by treatment for those conditions, such as cognitive behavioral therapy. Building in care management support to assist in navigating the treatment process may reduce the possibility of relapse and/or readmission to a substance abuse inpatient or residential rehabilitation program. It also helps provide individuals with the tools needed to live addiction-free.

By taking the time to dispel the myths about non-traditional addiction treatment like MAT, we create an environment that more fully supports a return to complete health—physical, mental and emotional. Fighting the stigmas around MAT is an important step toward enabling those suffering from OUD to recover from their addiction and live healthy, vibrant lives.

For healthcare providers, prior authorization (PA) via fax or telephone is the second most costly medical administrative function. On average, medical staff spend two business days per week on PA. Automating PA while maintaining clinical excellence is essential for better care delivery. With a focus on leveraging digital solutions and fostering data-enabled decisions, Magellan Healthcare is building more provider-friendly approaches to improve care.

Recently Magellan announced a collaboration with Stanson Health, Premier, Inc.’s clinical decision support (CDS) technology division, to deploy DecisionPoint, an industry-leading automated PA solution. Powered by Premier’s CDS technology, DecisionPoint is available at the point of care and supports true automation within the electronic health record (EHR) and the physician workflow, making the PA process easier and more efficient for providers, patients and health plans.

DecisionPoint is built with Magellan Healthcare’s Advanced Imaging Management program clinical guidelines and Premier’s award-winning technology platform. Magellan maintains one of the industry’s most comprehensive evidence-based sets of clinical guidelines. Our clinicians develop our criteria through an extensive process of innovation and refinement. We base these guidelines on the analysis of public, peer-reviewed articles; health plan medical policies; the Centers for Medicare & Medicaid Services (CMS) policies; specialty physician reviews, professional society guideline statements; and other rigorous reviews of scientific documents. We continually monitor peer-reviewed literature, professional society guideline statements, and CMS-covered criteria to update our guidelines regularly, no less than annually. Initially, DecisionPoint will include our suite of the 20 highest-volume advanced imaging studies that make up 85% of all requests.

Working directly in the EHR, DecisionPoint guides provider decisions in real time in response to key workflow events, such as ordering an advanced imaging study. Integrating within the EHR improves efficiency while ensuring safety and quality and reducing undesirable variation in care.

Rules-based programming leverages EHR data, locating all relevant patient clinical information and citing appropriate Magellan clinical guidelines. Requests that satisfy the clinical guidelines are automatically approved and posted in the EHR, and approval IDs are automatically loaded to the record. With a confirmed authorization determination, the member leaves the appointment with a clear plan of action.

Hawai‘i Pacific Health (HPH), one of the largest healthcare providers in Hawai‘i, is leading the way in automating prior authorization by piloting DecisionPoint to help ensure their patients receive real-time, evidence-based decisions at the point of care whenever possible. Administered through HPH’s Accountable Care Organization (ACO) with over 800 physician members, the pilot leverages Magellan’s clinical guidelines and our full panel of clinical experts. We expect DecisionPoint to be available to additional providers in the fourth quarter of 2019 and include additional specialties and tests in the future.

The healthcare industry is in the midst of a significant paradigm shift as it transitions from a fee-for service model to value-based care. As a technology-augmented service backed by the support of providers, DecisionPoint is designed to minimize the industry’s challenges by fully integrating with EHRs at the point of care to enable faster PA and help deliver on the triple aim—improved quality, reduced cost and improved patient/provider experience.

To learn more about DecisionPoint, click here to go to our website, or email ProviderSolutions@MagellanHealth.com.