Although 21% of U.S. adults have a mental illness, access to behavioral healthcare remains out of reach for most. From 2008 to 2019, the number of adults with any mental illness increased nearly 30%. The pandemic further exacerbated mental health problems for adults and sparked an expanding youth mental health crisis. As the demand for behavioral healthcare continues to grow, Magellan Healthcare recognizes the need to increase access.

Increasing Access to Evidence-based Care

Magellan has collaborated with NeuroFlow, an award-winning behavioral health technology company, to increase access to our evidence-based digital cognitive behavioral therapy (DCBT) programs and enhance engagement. With a history of over 20 years of research and development and an endorsement from the Substance Abuse and Mental Health Services Administration (SAMHSA), Magellan’s DCBT programs are integral components of our Digital Emotional Wellbeing program, including FearFighter® for anxiety, panic and phobia and MoodCalmer for depression. Both programs, as well as RESTORE® for insomnia and other difficulties sleeping, are available online in Spanish, further increasing access to evidence-based programs.

Understanding Digital Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a short-term intervention that behavioral health clinicians use to help individuals overcome negative thoughts and behaviors. CBT is effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. CBT has been demonstrated to be as effective in certain conditions as other forms of therapy or psychiatric medications. Digital CBT (DCBT) is the implementation of CBT on a digital platform with the same core principles, language and exercises used in live practice that include:

• Learning to recognize thought distortions
• Evaluating distortions against reality
• Gaining a better understanding of others’ behavior and motivations
• Using problem-solving skills
• Developing a greater confidence in one’s own abilities
• Changing behavioral patterns
• Developing coping skills

True evidence-based DCBT follows the exact CBT process, differing from evidence-informed digital programs that use some CBT practices but are not built with fidelity to the intervention model. Learn more about evidence-based vs. evidence-informed behavioral health interventions here.

Impact of FearFighter and MoodCalmer on Mental Health

Our collaboration with NeuroFlow has yielded remarkable outcomes that underscore the power of innovative partnerships. In a recent study, members participating in the Digital Emotional Wellbeing program who completed 75% or more of FearFighter and MoodCalmer reported significant reductions in anxiety and depression symptoms within 90 days.

• FearFighter users experienced a 41% average reduction in Generalized Anxiety Disorder Assessment (GAD-7) scores, compared to other DCBT users who averaged an 11% reduction in GAD-7 scores.
• MoodCalmer users experienced a 24% average reduction in Patient Health Questionnaire (PHQ-9) scores, compared to an average 13% reduction among those who completed less of the program.

Beyond these impressive results, Magellan has seen a 124% increase in registrations after launching Digital Emotional Wellbeing over previous programs. Members also report high levels of satisfaction with the Digital Emotional Wellbeing program with 85% indicating they would recommend the program to someone else.

Visit Magellanhealthcare.com/digital-bh/ to learn more about the results and how our Digital Emotional Wellbeing program, including our award-winning DCBT programs improve anxiety, depression and more.

Sources:

• Exploring Barriers to Mental Health Care in the U.S. | AAMC
• What is Cognitive Behavioral Therapy? (apa.org)
• Satiani A, Niedermier J, Satiani B, Svendsen DP. Projected Workforce of Psychiatrists in the United States: A Population Analysis. Psychiatr Serv. 2018 Jun 1;69(6):710-713. doi: 10.1176/appi.ps.201700344. Epub 2018 Mar 15. PMID: 29540118.

FearFighter® and MoodCalmer are owned by CCBT Limited Corporation, United Kingdom. CCBT has granted Magellan exclusive rights to FearFighter® and MoodCalmer in the U.S.

Nikki Walker is the director of Federal Program Management with a focus on business innovation for the Magellan Federal Military and Family Life Counseling (MFLC) program. Walker, who has been with Magellan since 2012, oversees innovation projects and pilot initiatives that are either directed by our government customer or in collaboration with Magellan Health. Currently, Walker is working on the NeuroFlow pilot and the Arammu Relationship Checkup, a web-based counseling tool that allows military couples to check the status of their relationship health. They also learn how to manage strengths and challenges in their relationship with help from MFLC counselors. Continue reading to learn more about other innovative projects and pilot initiatives Walker is working on at Magellan Federal.

What sort of innovation projects are you currently working on at Magellan Federal?

I’m currently working on two exciting pilots that are moving the MFLC program forward into a digital dimension. The NeuroFlow wellbeing application is part of Magellan Healthcare’s eMbrace employee assistance program. Magellan Federal has also collaborated with NeuroFlow on a pilot program tailored specifically for the military population that incorporates additional safety features. Our relationship with the NeuroFlow team has allowed for a successful rollout at three military installations.  This is truly innovative work within the Magellan Federal business, and we’re excited to be able to offer this type of resource to our military members.

Another pilot we’re working on is the Arammu Relationship Checkup. It’s a digital-based questionnaire that allows military couples to rate their relationship health. Couples can go online and confidentially complete the questionnaire. The results of the questionnaire are immediately presented to the couples and provides concrete techniques to help them enhance their relationship wellbeing. The Relationship Checkup has had a positive impact on how we conduct non-medical counseling. Our MFLC counselors can use the Relationship Checkup in their non-medical counseling sessions to talk with couples about their strengths and any challenges they may work on to build their relationship. The pilot has been successful, and military couples have been very receptive of the checkup.

Why is Magellan Federal the best place to do these projects?

I believe Magellan Federal emphasizes collaboration as well as delivery. We deliver what’s expected of us when innovative programs are requested. Also, when we are working on business development, we are very good at identifying its key partners and stakeholders who are critical to successfully execute and deliver the product or the service that is expected. This collaboration is at all levels and within different arenas: government, military, community, greater Magellan Health, and internal Magellan Federal teams. We’re good at collaboration and building relationships, which help us deliver value to the customer.

What are your thoughts on the culture at Magellan Federal?

The Magellan Federal culture thrives on precision and accuracy. Getting things done right is very important. That supports what I’ve said about delivery. Our culture is about getting it right, which speaks to our professionalism, attention to detail, and the quality of the work we deliver. It’s that high level of professionalism that’s really rooted in delivering consistently. This is engrained in our culture. It speaks to the high level of quality work that our partners, the government, and the military want to see and why they continue to come back to us.

What exciting trends in the healthcare industry, related to military healthcare, have you noticed? In what direction do you see healthcare going? What lessons are there to learn in other industries that can be applied to healthcare?

One of the biggest trends is self-directed wellbeing or self-directed care. Many of our military members and families want something at their fingertips that allows them to easily access and navigate their healthcare. It’s mobile first. Cell phones and the web are readily available to service members, so being able to deliver wellbeing and healthcare services by phone or web gives them the opportunity to get the care they need, when and where they need it. This is especially important with our younger service members and spouses.

Lessons from other industries we can learn from include how to diligently explore the best way to operationalize research-based work. Pilot programs are often based on clinical and research studies, which is good because you do want evidence-based work. But we must also have due diligence in properly translating evidence-based work into daily operations. That takes time and skill. We must be able to think through how to manage and mobilize the workforce to be able to deliver the product and the service. Being able to successfully transition from a clinical study to operations is a big task. Having a plan of action on how to mobilize your team and how to operationalize that clinical study is especially important.

Learn more about the various solutions provided by Magellan Federal here.

Kristen Ford, vice president of product innovation and development for behavioral health, has led many new innovative products being developed at Magellan Health. In her position, Ford is responsible for the product innovation and development activities for behavioral health solutions. Ford, who is based in Oregon, has worked for Magellan Health for 12 years on various innovation strategies focused on best-in-class services that help members live healthier lives. She is a Six Sigma Black Belt and a clinician who’s passionate about driving human-centered product development that changes lives. Most recently she’s helped to launch a full continuum population health wellbeing solution to improve population engagement into evidence-based care and improve the quality and accessibility of healthcare for those that are thriving, struggling or suffering. Continue reading to learn more about Ford’s work on these innovative products:

What cool, innovative products are you currently working on?

My responsibilities focus on new products that drive growth, leverage Magellan Health’s thought leadership, and enhance the lives of the people we serve. One example is the development of a comprehensive autism strategy where we are creating new mechanisms for timely access to autism screening with faster diagnosis to improve early intervention. We are laying the groundwork for new clinical models that intertwine technology, diagnostics, therapeutics and facilitate better coordinated care for the whole child.

We’re also working on other complex areas of healthcare such as suicide prevention. We care deeply about the recent increase in population suicide trends and our mission is to make suicide a never event. We do that through creating solutions that empower individuals with knowledge, education and tools in an environment of uninterrupted and supportive care.

Medical integration is another area of focus with our new collaborative care product which improves medical and behavioral health integration by making it easier for primary care physicians to diagnose and treat members’ behavioral health condition in the office. We’re looking at ways to solve important challenges in the delivery of behavioral healthcare by working on solutions that enable navigation, digital engagement, transform the delivery system and offer new models of care.

Can you expand on the work you’re doing with projects like Mightier, NeuroFlow and DUOS?

Mightier is a biofeedback gaming solution that teaches children emotional regulation to help them manage big emotions and teach calming strategies. This is important because it offers a bridge to care for children and families that are struggling. It’s been shown to be highly effective in randomized control trials for children with autism, ADHD, OCD or other similar conditions. It’s improved oppositional behaviors in children and decreased caregiver stress. We’re currently working with Mightier on a study through the National Institute of Mental Health to show that using this type of intervention can improve quality and cost of care.

We’re also working with NeuroFlow to deliver a collaborative care product, which expands Magellan’s value proposition with the ability to manage total cost of care. NeuroFlow brings the technology, and Magellan provides the clinical management which has resulted in a solution that is highly appreciated by our clients. We also launched the NeuroFlow population health app which provides digital wellbeing and self-care tools, including our digital cognitive behavioral therapy modules, to help members improve overall health and wellbeing, manage stress and build resilience in a confidential manner.

DUOS is an opportunity for us to address the social determinants of health and needs of older populations. DUOS provides a personal assistant for aging – a DUO – to help older adults stay healthy and age independently in their own homes. We connect older adults with social support and resources to manage social isolation, healthcare access and behavioral health needs. In our pilot results, we found that 97% of seniors were linked to resources to meet their needs and has high satisfaction with a net promoter score of 88.

Why is Magellan Health the best place to build new innovative products?

We are fortunate to have an executive leadership team that developed a culture that supports innovation. It’s part of our DNA. We have been successful in evolving our innovation strategy that positions Magellan as a thought leader and innovator in the behavioral health and wellbeing space. Our executive leadership believes that innovation is essential in treating the whole person, achieving growth and moving our business forward.

What are your thoughts on Magellan’s culture? How has that culture impacted the products you’ve worked on?

I think it’s a highly collaborative and team-oriented culture. Everyone is willing to roll up their sleeves and help achieve the best outcomes. The Magellan culture is purpose and mission driven. Everyone you encounter is focused on the best ways to support our customers, ensure members have the best experience and they’re getting the best care possible. I think that’s the picture of Magellan and it’s a wonderful place to work and drive innovation.

Currently, we have a pipeline of over 44 different products or product enhancements that we’d like to explore. People are familiar with Magellan’s culture of dedication and innovation. As a result, they are willing to collaborate and advise us as we drive towards solutions that can improve the lives of those members we serve.

What exciting trends in the healthcare industry have you noticed? What direction do you see healthcare going? What lessons are there to learn in other industries that can be applied to healthcare?

There are new trends in the field of autism related to clinical advancement and how we work with children on the spectrum as well as exciting developments and solutions in managing the total cost of care. There are new approaches that allow us to combine technology and clinical acumen deliver new care models. The pandemic created an environment where members and providers used new technologies and tools out of necessity which now provides us opportunity to continue to build and accelerate the adoption of new care models through technology. We are also seeing new and exciting opportunities to engage and activate members while reducing stigma.

Some industries can market directly and successfully engage the end user. We can learn from those industries and drive growth through that engagement.

We are fortunate that the Magellan leadership team and culture supports us in exploring those recent trends and solving for some of the most difficult challenges we see in service delivery.

Behavioral health is an important indicator of a society’s overall wellbeing, as it interacts closely with physical health. Unfortunately, most individuals do not receive the behavioral health treatment they need. Fear of treatment, shame, and embarrassment keep many from seeking care. More than one-third of Americans live in areas lacking mental health professionals.[1] Fifty percent of individuals who receive a behavioral health referral do not follow through or have only one visit.[2] Collaborative care addresses these problems by providing physical and behavioral health care in the primary care setting.

What is collaborative care?

Collaborative care is a specific type of integrated care developed at the University of Washington’s AIM Center that treats common mental health conditions, such as depression and anxiety, that require systematic follow-up due to their persistence. Based on principles of effective treatment of chronic illness, collaborative care focuses on defined patient populations tracked in a registry, measurement-based practices, and treatment to target. Trained primary care providers and embedded behavioral health professionals provide evidence-based medication or psychosocial treatments, supported by regular psychiatric case consultation and treatment adjustment for patients who do not improve as expected.[3]

Principles of collaborative care

Developed in consultation with a group of national experts in integrated behavioral health care in 2011 with the support of the John A. Hartford Foundation, The Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, and California Healthcare Foundation, five core principles define collaborative care and should inform every aspect of implementation to ensure effective collaborative care is practiced.[4]

• Patient-centered team care—Primary care and behavioral health providers effectively work together using shared care plans that include patient goals. Being able to receive both physical and mental health care in a familiar location provides patients with comfort and reduces duplication of assessments. Increased patient engagement often leads to a better health care experience and improved patient outcomes.
• Population-based care—Care teams share a specific group of patients that are included in a registry. The registry is used to track patients and ensure that no one falls through the cracks. Patients who do not show improvement are outreached, and behavioral health specialists offer caseload-focused consultation.
• Measurement-based treatment to target—Each patient’s treatment plan includes personal goals and clinical outcomes that are measured using evidence-based tools, such as the Generalized Anxiety Disorder scale on a routine basis. If patients do not improve as expected, treatments are adjusted until clinical goals are met.
• Evidence-based care—Patients receive treatments with sound research evidence to support their efficacy in the treatment of the target condition, including various evidence-based psychotherapies that have proven effective in primary care, such as problem-solving treatment, behavioral activation, and cognitive behavioral therapy, and medicines.
• Accountable care—Providers are responsible for and receive reimbursement for the quality of care and clinical outcomes, not just the volume of care provided.

Collaborative care has been proven to double the effectiveness of depression care, improve physical function, and reduce health care costs. Magellan Healthcare’s evidence-based Collaborative Care Management product, enabled by NeuroFlow, provides care management and psychiatric consults for primary care patients and augments physical health providers’ staff with Magellan staff to facilitate integrated physical and behavioral healthcare. Learn more here.

[1] https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/

[2] https://aims.uw.edu/collaborative-care

[3] https://aims.uw.edu/collaborative-care

[4] https://aims.uw.edu/collaborative-care