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

It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

No one is exempt from experiencing the effects of the opioid crisis. Magellan’s own Janet Edwards, RN, senior clinical director of Magellan’s Chronic Pain Management program, describes how close to home the opioid epidemic hit her:
It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

“My daughter, Nikki, was 26 when she  died of a Fentanyl overdose. As the mother of a six-year-old and a critical care nurse working in a respected healthcare organization, Nikki was the picture of success. But to handle the pressures of nursing school, a full-time job, and life as a single mother, Nikki sought prescriptions for Adderall and Xanax from multiple physicians. Over time, her addiction to these substances gave way to a new addiction: Fentanyl, which she began to confiscate from the critical care unit where she worked.
Like many others, Nikki didn’t show any signs of addiction. But five years after her son was born, Nikki sat at my kitchen table and admitted that she was addicted to heroin. She was afraid to get help, because she did not want to lose her job or the respect of her peers. She insisted she could recover on her own. Even though I, as a nurse, knew the odds were not good that Nikki could manage her recovery alone, I respected my daughter’s wishes. It’s a decision I will forever regret. Eleven months later, Nikki died of an accidental overdose in front of her son and a friend.”

Following the loss of her daughter, Janet has openly shared Nikki’s story, becoming an advocate for helping prevent opioid addiction. Further, Janet has taken on clinical leadership of Magellan’s Chronic Pain program, which offers alternatives to opioid use.

Meeting opioid users where they are

No matter where or how someone encounters opioids or where they may be in the cycle of use, dependence or addiction, Magellan offers many other ways to address the opioid problem. Our behavioral health products forged from decades of serving the public, our specialty healthcare solutions supported by clinical excellence, and our customized pharmacy programs are ready to answer the call as organizations and individuals look for answers.
Hosting a forum for sharing successes  and discussing solutions

In September 2018, Magellan brought together  national and local leaders in Pennsylvania to  exchange ideas, share successes and  discuss solutions to the opioid  epidemic in our communities.  The free, second-annual  conference featured  keynote addresses and  workshops and highlighted  the proactive efforts of local  organizations. Participants included  national and state officials, county human  services and drug and alcohol leaders, legislative  staff, providers and community stakeholders.

Not staying silent on the silent epidemic

Magellan is actively helping individuals and families on their path to recovery. Further, to educate the public, doctors and other healthcare providers, we offer resources on our Magellan Health OPIOID INSIGHTS microsite. The site includes links to blog posts, videos, resources and published articles.

Hosting a forum for sharing successes and discussing solutions

InSeptember2018, Magellan brought together national and local leaders in Pennsylvania to exchange ideas, share successes and discuss solutions around the challenge we face together in addressing the opioid epidemic in our communities. The second-annual conference featured keynote addresses and workshops and highlighted the proactive efforts of local organizations. Participants at the free one-and-a-half-day conference included national and state officials, county human services and drug and alcohol leaders, legislative staff, providers and community stakeholders.

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

Learning and evolving aren’t just how we approach doing business. Magellan is committed to helping people reach their fullest human potential. But reaching your fullest potential could get derailed at any minute by a disaster.

Serving state employees during their toughest moments

The Camp Fire, which began November 8, 2018, was the deadliest and most destructive wildfire in California history to date. It destroyed much of the town of Paradise, took 85 lives, and destroyed 13,972 homes, 528 businesses and 4,293 other buildings. The fire was followed by severe flooding. As the Employee Assistance Program (EAP) provider to the State of California, Magellan was immediately there to help. Through centralized specialty critical incident stress debriefings (CISDs), Magellan provides structured on-site support to employees who have been impacted by a traumatic event.

Delivering an employee wellness strategy best practice

CISDs give employees access to immediate, expert and compassionate support to help them understand and process their feelings about the traumatic event. Magellan can also recommend additional resources available through EAP, such as legal and financial assistance, and provide referrals to community resources. And, where appropriate, we provide one-on-one follow-up support. Magellan’s dedicated call center is available 24/7 and is staffed with trained clinical professionals to take calls and work with employers to develop appropriate support.

Providing support in critically stressful times

Magellan provided more than 40 CISDs for over 300 California state agency employees in response to 2018 wildfire and flooding natural disasters. Magellan CISD provider Shammy Pius, MFT, describes her experience leading debriefings for the Camp Fire event:

“I conducted numerous sessions with state agency employees, many of whom had to cope with their own personal losses while serving and supporting others. The support Magellan gave state employees was beneficial to them but also had a positive ripple effect in their communities. The group sessions helped employees feel like they weren’t alone. The feelings they were experiencing were normalized when they heard that their colleagues were also experiencing anger, sadness and stress. Importantly, it was essential that each employee not minimize their own experience.    Everyone felt disruption to some degree. Educating them about resiliency and coping techniques during the event and soon after encouraged employees to accept the support that was offered to them. We help set the expectation that recovery will take a while, but there is hope and things do get better over time. It’s incredible how people come together in times of adversity – it’s truly heartwarming. I’m essentially a stranger going into these workplaces, and I get to be a part of people’s journeys during some of their most difficult times. It’s an honor to me to do this work  for Magellan.”

Evolving through our experiences

Magellan’s team responds to more than  5,000 critical incidents annually. Our CISD program offers access to a network of 8,100+ masters-level clinicians with crisis intervention training. We intervene carefully and thoughtfully, listen, reassure and teach resiliency. We wish these services were never needed, but since they unfortunately are, we embrace them as times to learn, evolve and help others live healthy vibrant lives.

Satisfied customers

•   99% of clients said the CISD plan was easy  to arrange and done in a timely manner
•   98% of clients said the EAP counselor was professional, courteous and understood their needs In response to tragedies and detrimental weather events, Magellan sets up a 24-hour toll-free hotline for individuals to access, regardless of whether or not they are Magellan members.

The 24-hour crisis lines are staffed by behavioral health professionals who provide free, confidential consultation services and other resources, such as referrals to local non-profit organizations, shelters and additional community based support.

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.

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.

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 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.

©1997–2019, Healthwise, Incorporated

Read the full article here: https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=uf4898

“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!