Magellan Behavioral Health of Pennsylvania, Inc., a Medicaid managed care organization (MCO), started as the new HealthChoices behavioral health exclusive contractor for the Cambria County Behavioral Health Services Program on July 1, 2017. Magellan currently administers behavioral health benefits for Medicaid members through HealthChoices contracts with Bucks, Delaware, Lehigh, Montgomery and Northampton counties.

Magellan has over two decades of experience managing behavioral health benefits for HealthChoices members through close collaboration with members, providers and community organizations. Through this collaborative mindset, Magellan has succeeded in producing innovative efforts in the following areas:

• increases in access to care
• improved service use rates
• expansion of the continuum of services in alignment with evidence-based models
• maximization of clinical appropriateness
• nationally recognized level of quality services

Read more about Magellan’s collaboration with Cambria County, local providers, community organizations and members in the Tribune Democrat: New Behavioral Health Provider Brings Options, Jobs to Cambria County.

Stacy Ellingen is a woman from Wisconsin who’s never met an obstacle she couldn’t overcome. After graduating from high school, Stacy left home to attend the University of Wisconsin-Whitewater. After graduating with a degree in journalism and advertising, she moved to Oshkosh. Now in her thirties, Stacy leads a busy professional life as a small business owner and an independent contractor with InControl Wisconsin, an organization that plays a key role in advancing self-directed supports in the state. She’s become more involved in disability advocacy efforts and the community.

Stacy’s story is a successful one—living independently for more than five years, finding a job about which she is passionate and becoming involved in her community. But now consider this success as part of Stacy’s larger story – she grew up with cerebral palsy, resulting in complex physical support needs. However, Stacy grew up believing that she could do everything others do. Working with her self-directed support consultant, Kathi Miller, an employee of TMG by Magellan Health, Stacy proved she could do everything others do.

“Kathi has helped me reach my goals in many, many ways,” Stacy said. Kathi and Stacy joined forces to identify community home care providers to support Stacy in meeting her daily needs at home and at work. They partnered to identify ways that Stacy could make responsible budget decisions in purchasing services to meet her goals. When developing her small business, Kathi supported Stacy in connecting with the local business community to create professional peer connections that enhanced her business development strategies. “Most of all though, Kathi encouraged me to keep moving forward when things got tough! She has been amazing!” said Stacy.

Download a copy of this infographic here.

Being a parent is one of the most challenging and rewarding jobs an individual can hold. When behavioral health challenges are added, it becomes even more difficult. Try, for a moment, to imagine being a foster parent to a child with behavioral health challenges. Where does one even begin to find the help and services they need to best care for their child?

Through our collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan in Wyoming coordinates care, including behavioral health interventions with other youth serving agencies in our system, using the High Fidelity Wraparound (HFWA) model to build a team of support for the successful management of complex conditions and behaviors in home- and community- based settings. The team creates steps to help youth stay in their homes, schools and communities. Through the 10 guiding principles of the program, families and youth have a voice in their care and choice in the kind of care they receive. We help to strengthen community support, understanding, and education of at risk youth ages 4-20 with complex behavioral health needs.

Magellan in Wyoming recently had the opportunity to hear from a former foster parent and HFWA graduate to discuss how the program benefited them through their challenges and supported their growth. “Opening my heart up to love and attachment with these children, parenting them with unconditional love, all the while knowing, they might not stay was difficult,” said the foster parent.

The siblings involved and their foster family cycled through numerous foster care workers in three years, creating more trauma for everyone. There was no stability and no consistency. Dealing with several different mental health diagnoses and many weekly appointments, in addition to the strain of everyday life, took a toll.

When this family discovered HFWA, they were naturally a little skeptical. They had experienced enough “new” things; however, this was the beginning of a completely new outlook on life. From the very start, HFWA taught the foster parent that it was okay to take a breath, to sleep and to ask for support. More importantly, it became evident that people wanted to help and be on the family’s team to help support them.

The family had spent so much time triaging the risk aspects of their children’s lives, that it had drained them of most of their hope. Through the strengths-based principles of the HFWA program, the family was able to gain new insight into ways they could focus on the local supports available to help them.

The program taught them to see the progress. By forming a HFWA team around the foster children and the whole family, they were able to gain some positive, strengths-based perspective along with stability and consistency.

HFWA empowered the family to have a voice and to use it effectively. “I knew all the people on my team before HFWA, but the program taught me how to use my voice. It taught me how to say what was going on and who to say it to,” said the foster parent. It was because of the family’s team, as well as community investment in the program, that today, the family is enjoying a life full of hope and possibility.

To mark Mental Health Month, we had the opportunity to sit down with Dr. Caroline Carney, chief medical officer of Magellan Healthcare. Dr. Carney shed some light on stigma, barriers to mental health services and ways we can all help all friends and family get the treatment they need to live a healthy, vibrant life.

Why is there still a stigma around seeking help or treatment for mental health concerns?

Dr. Carney: I think we first need to talk about what stigma is, and where it comes from.

Unfortunately, people with mental illness have been stigmatized by others, and even by themselves. Mental illness is often still perceived as an indulgence, a sign of weakness, or as a character weakness. You also may find people who believe mental illness is something that is scary, or to be made fun of. So many myths exist about mental illness, including that it is the result of bad parenting. Popular culture continues to further the stereotypes and myths.

Further, self-stigmatization is a huge driver for this. Self-stigmatization occurs when shame and secrecy override even the most extreme of symptoms, preventing people from getting the help they need. Few people recognize how prevalent mental illness is.  We don’t talk about depression. We don’t talk about our own perceived failures. We don’t talk about how tough life can be, and often suffer through it in silence. Further, the symptoms themselves, whether depression, anxiety or psychotic disorders, often contribute to a sense of isolation. In the time of Facebook and Instagram, we are led to believe that everyone lives a happy and interesting life every day. If you feel you don’t measure up to what is shown on social media, it can then be perceived as a failure. This is especially true for adolescents, teens and college-aged kids. I’ve spoken recently to a young person who was afraid to talk to her best friend and to her mentor about her feelings of depression and loneliness. She was afraid they would think that she was weak and flawed—therefore not worthy of being a good friend. Instead, she suffered in silence, further worsening the symptoms until suicide became part of her daily thoughts. Most people around her would never recognize this incredible kid regularly thinks of suicide. This, unfortunately, is an all too common scenario.

What can friends, family and coworkers do to help lessen that stigma and encourage people to seek help?

Dr. Carney: I think the biggest step is to support and withhold judgement. Family and friends need to be upfront about symptoms or conditions they’ve had in their own lives. I often advise that it is a normal, common thing to get treatment—it should be considered no different than getting treated for any medical condition. In some cases, friends and family may find themselves helping someone access treatment at a mental health provider or a primary care physician. Emphasizing that mental illness isn’t a sign of failure, and can actually be treated, is critically important. As a doctor, I have often counseled the loved ones of my patients that it can be frustrating to take care of a person in the thick of an episode of mental illness. The symptoms of depression, for instance, dampen ones motivation, support beliefs of hopelessness, and take away energy. It should be no surprise, then, that the person suffering from mental illness doesn’t want therapy. Don’t give up on them—understand that the disease itself influences getting treatment.

Treatment for mental illness doesn’t happen overnight—it can often take weeks or even longer for a response to occur. Family, friends, coworkers, and providers shouldn’t give up.  Look for incremental change, not overnight cures.

What is the biggest misperception about mental illness? 

Dr. Carney: The biggest misperception is that mental illness isn’t an illness—that is something one brings upon oneself. Mental illness is caused by biological, genetic, and environmental factors.

Can you live a life of recovery?

Dr. Carney: Absolutely! Because mental illness is a medical condition, it’s important to know about different mental conditions and their associated treatment options. A common myth is that the illness will go away if a stressor is removed, or time passes, or a person just thinks positive thoughts or prays. Think about a physical illness such as diabetes. Diabetes won’t go away with positive thinking, and neither will a condition like depression. Mental illness can be treated, and the earlier treatment is initiated, the better the chances of recovery. Finding licensed, trained providers is essential. Using social supports like faith or your peers can be an extension of, not a replacement for, treatment.  Importantly, having an episode of depression or an anxiety disorder may only occur once in a lifetime. If the root causes are uncovered, cognitive distortions are addressed, and if appropriate, medication used correctly, the morbidity of mental illness can be markedly reduced, and may never come back. Even people with serious persistent mental illness, such as schizophrenia, can live a life of recovery with the right supports and treatment.

But I also think it’s essential that we need to educate people that the illness may return. This doesn’t mean that a person with mental illness failed. It means that the illness may be chronic, but the symptoms can still be treated.

The most vital concept to remember is that recovery is possible, and can be permanent.  When it’s not permanent, treatment can be ongoing and very successful.

What can providers/clinicians do to help reduce stigma?

Dr. Carney: I think there are a few ways that everyone – not only providers or clinicians – can help counter stigma around mental illness.

• Know the facts about mental illness—read about mental illness from expert and advocacy groups like the National Alliance on Mental Illness (NAMI), the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration (SAMHSA) and other sites.  Rumor and innuendo never serve the facts.
• Continue to reinforce that this is an illness, and not a sign of weakness or failure.
• Take a look at your own attitudes and how you think about mental illness—whether your own, in someone you care about or the stranger you see on the street.  Understand that no one would ever want to be depressed, or be troubled by hallucinations. Mental illness is an illness, no less than heart disease or cancer.
• Choose your words carefully—Often we refer to someone who has diabetes as a diabetic, or a person with schizophrenia as a schizophrenic. People are more than their disease, whatever it may be. We need to preserve personal dignity by recognizing that our words matter—use terms like “he is a man with schizophrenia,” and be mindful of common phrases like “crazy” or “nuts.”
• Provide support by keeping your loved one or friend safe from harm. Participate in therapy when asked. Avoid passing judgement, especially about how quickly someone’s recovery may be progressing, and continue to support the receipt of treatment.
• Take an honest look about what environmental factors may be contributing to the illness.  Evaluate short-term and long-term stressors.  Just like we would monitor the diet for someone with diabetes, we should recognize that environmental factors contribute to mental illness, just as they do to physical health.
• Never accept or foster stereotypes.

Between January 30 and February 1, Magellan hosted its Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. Our annual gathering of healthcare insiders, experts and leaders provides opportunities for key members of the industry to talk openly about the future of healthcare. You can read part one of our review of the 2017 event here.

Building and Planning for the Future

Day two keynote speaker, Salim Ismail, chair of ExO Works, best-selling author of Exponential Organizations and former executive director of Singularity University, gave a fantastic overview of the exponential business model and how it applies to healthcare. Pointing to a wide variety of other industries, Ismail showed that disruption is powerful, creating both problems and opportunities. If a company fails to respond, it can quickly become overwhelmed — case in point, the photographic industry’s reaction to digital cameras. When the public embraced digital imaging, the market for film and film development disappeared; however, a whole new slew of problems arose allowing opportunity to flourish. In this case, the large number of images created by the average person needed new solutions, namely how to store and organize their digital pictures.

Ismail explained that there was a doubling pattern of exponential growth in a basket of many technologies. He also pointed out that humans are, in fact, not very good at accepting exponential growth. Our brains do not track exponential growth well, preferring scalable efficiency. Ismail gave advice on how companies (in healthcare and beyond) can prepare themselves to not just deal with exponential change but to lead it. Michael Guyette, president and CEO of Blue Cross and Blue Shield of Minnesota (BCBSMN), gave some key insights into how that spirit of disruption and innovation can look in the healthcare world. Guyette relayed how BCBSMN had created a unique program focused on innovation and diversification that has resulted in ways they can improve the health of communities they serve. “You need to have focus. Otherwise, you’re just going to go all over the place with innovation,” Guyette said. “But we as leaders need to make sure that we embrace our legacy while we start to reach out for the change of the future.”

Big Data Leading to More Personalized Care

One particularly interesting discussion centered on the rise of big data. While the concept of data-driven healthcare may seem impersonal at first glance, several voices argued that it can actually lead to more personalized care. For example, Michael Neidorff, chairman, president & CEO, Centene Corporation, brought up software that track genetic and genomic patterns. This data can be used to map cancer at the individual level, allowing for personalized care. Similarly, the ability to collect and process personal health data was brought up by Seth Dobrin, vice president and chief data officer at IBM Analytics, as a powerful and personal disruption of the health care industry.

Brian Flanigan, principal at Deloitte Consulting, brought up the fact that healthcare is in an affordability crisis. 76 percent of consumers rate the healthcare system as poor or average and costs are rising to unaffordable levels. Flanigan pointed to the use of innovation and data to provide the high-level, personalized services that consumers demand at more affordable prices. Using data and new technology, Flanigan pointed out, will literally allow us to do more for less.

Discussion with Peers and Experts

When we first developed the Magellan Open Vision Exchange, we wanted to avoid the typical corporate conference format and create a genuine exchange of ideas and experiences between healthcare peers and insiders. Once again, we were thrilled with the level of dialogue, questions and answers that we heard from our speakers and panelists.

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.

According to the Kim Foundation, one out of four Americans experiences behavioral health issues. Of those, 60 percent are not receiving treatment.

Why are so many people not receiving treatment?

What does this mean for providers?

What more can be done to increase access to behavioral healthcare?

Learn more about this issue by downloading Magellan’s new infographic, “Mind the Gap: Increasing Access to Behavioral Healthcare.”