Finding solutions that allow individuals to improve their overall wellbeing has been Sara Pierce’s primary focus with the recent launch of eMbrace on April 1, 2022. As senior vice president of strategy and execution, Pierce has worked closely on the collaboration between Gallup and Magellan Health and the creation of the Magellan-Gallup Wellbeing Project. With over 10 years of experience working at Magellan, Pierce is a leader on the Growth Team where she’s responsible for the team’s Go-To Market strategy (GTM) and leads individuals on the sales operations, the sales training, and customer experience teams. Pierce, who is based in Connecticut, discusses her ongoing work with Gallup on projects including eMbrace, and how Magellan’s culture has been instrumental in its success.

What sort of innovative projects are you currently working on?

I think the most innovative and fun project I’m working on right now is related to our collaboration with Gallup. We’ve created the Magellan-Gallup Wellbeing Project, joining  forces to combine Magellan’s 50 years of behavioral health experience with Gallup’s industry-leading insights and research to understand how we can better meet the needs of individuals and improve their overall wellbeing. Gallup’s State of the Global Workplace Report tells us that roughly seven in 10 employees are struggling or suffering in their overall lives, with negative emotions at an all-time high. As an employer and a human this is deeply troubling to me.

eMbrace is a fully integrated, evidence-based solution for supporting members’ total wellbeing. We’re incorporating Gallup’s wellbeing assessment and then introducing different solutions or opportunities for employees to engage at all levels across the continuum depending on where they are in the six elements of wellbeing. In essence, we are breaking the silo that has until now separated employee assistance and clinical care, shifting an individual from coaching to employee assistance to clinical counseling based on what is happening in their life.

Do you have any other projects still in the planning phase?

We’re still in the thick of the recent eMbrace launch and it’s exciting that our own Magellan associates will be one of our first customers to utilize eMbrace. This provides us a valuable opportunity to “walk the walk” and to continuously learn from ourselves and our own team. At the same time, we are exploring how we can bring this important work to our health plan, public and Federals markets as well. This is only the beginning!

Why is Magellan Health the best place to do this project?

I think we are the perfect place to do this because of our over 50 years of deep clinical behavioral health experience. Our customers, whether they are employers, health plans, public or federal markets, all have one thing in common – they all have people who are struggling and suffering. The way I think about it, is if not us then who?

What are your thoughts on the culture here at Magellan Health? How has the culture at Magellan impacted your project?

I think one of the things that’s truly unique about Magellan’s culture is that everyone is singularly focused on our mission to help people. We take that very seriously. I think that’s a big part of who we are and why we do what we do and that it’s palpable. When you’re working on trying to solve big problems, it helps to bring it down to the individual level and understand that what we’re doing matters to a person, a family, and an employer. That culture informs everything we do.

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

We are in unprecedented times in terms of the rise in unmet need. More and more, as an industry, we are coming up with unique ways to try and meet those needs. One example of that is by addressing people earlier on in the continuum so that we can intervene to prevent exacerbation of illness. Offering digital assessment tools and interventions is one way to try and address the unmet needs. But of course, we can’t make the mistake of letting the pendulum swing too far in any one direction. I believe that our customers want us to balance digital and in-person. The right tools to the right people at the right time.

I think one of the problems in healthcare is that the industry has not designed solutions with the user experience in mind. Meanwhile in all other aspects of our lives, our tolerance for bad experiences is getting smaller every day. Our cell phones are continuously upgraded to improve our user experience. Products and services are marketed directly to us based on knowledge of our preferences, and we have countless choices in entertainment, retail, and restaurants. User experience is king in everything other than healthcare. For too long consumers of healthcare have been trapped with few choices. The good news is that every day I see more evidence that this is changing but we have miles to go before we rest.

Learn more about the dimensions of wellness here.

Have you heard that the world of cervical cancer therapy is evolving? There are two players who recently stepped onto the field of oncology for the treatment of recurrent, metastatic, or persistent disease. In 2021, FDA approval moved Keytruda® (pembrolizumab) from second-line to first-line therapy in PD-1 positive patients. Tivdak™ (tisotumab vedotin-tftv) also obtained FDA approval as second-line and subsequent therapy in the same space.

Why is the approval of two therapies in the same year significant? Since the 2014 approval of bevacizumab, no new first-line therapy for cervical cancer has hit the oncology market, and prior to bevacizumab, the last new approval in the category was the combination therapy with topotecan and cisplatin in 2006. So Keytruda and Tivdak are possible game-changers for patients!

From 1975-2010, new diagnoses of cervical cancer have decreased by more than 50% due to screening. With the introduction of the HPV vaccine in 2006, there was hope that HPV infection prevention would lead to decreased cervical cancer cases. In 2020, a Swedish study published in the New England Journal of Medicine found that the quadrivalent HPV vaccination was associated with a significant reduction in the risk of invasive cervical cancer. In 2018, there were 293,394 women living with cervical cancer in the U.S. As cervical cancer cases decline, according to SEER data, there were an estimated 14,480 new cases and 4,290 deaths reported in 2021. The total annual medical cost of cervical cancer care is estimated to be $1.6 billion. Due to its move from second to first-line, Keytruda will likely demonstrate a net neutral effect on the budget. A forecasted cost impact model for Tivdak is demonstrated below:

Sharon Butler is our leader of people strategies at Magellan Rx Management and is an integral part of our thriving culture. She inspires our teams to use their strengths to overcome challenges and deliver a pharmacy experience unlike any other. We sat down with Sharon to talk about her love of human resources, the current state of the industry, how the pandemic has affected HR professionals and how people make the difference in any organization.

What’s your background, and how did you get into Human Resources?

I love sharing this story because it’s the last place I thought I would be. I grew up in a poor neighborhood in Albany, NY in a family that didn’t value education. It wasn’t until I had the opportunity to attend college later in life that I met so many people who were resetting their path and going back to school after finding themselves in a job that didn’t fulfill them. It was then and there I realized my passion for people and believe there is so much more to illuminate a person if they are exactly where they want to be versus where they can be.

This realization led me to study organizations and leadership, dedicating my career to understanding the power of giving people an opportunity to do great things. There’s not an organization out there that’s great because of something other than people. If you think about it, organizations can’t achieve anything without people driving change.

How do you think your life experiences have shaped your work as a Human Resources professional?

I have learned through personal experience that some of the hurdles in your life are the ones you create and put in your own way. You can do anything if you have the passion and power to do it. You can’t just dream it. A dream isn’t a strategy, it’s the motivation that pushes you forward.

I’ve also learned that your career can have a huge impact on your overall wellbeing.

I have now been with Magellan for 14 years, and I’ve seen firsthand that when you tap into someone’s personal strengths, you unleash an incredible amount of potential within not only yourself, but your team as well. As a leader or manager, placing people in the right seat creates a highway for growth and development.

Our data tells us that we’ve had 455 internal promotions over the last 12 months and that we continue to focus on supporting effective career conversations and encourage every employee to start a conversation. I’ve seen a correlation between employee driven career discussions and success of achieving aspirational goals.

We can’t impact what we don’t measure. We are focused on pulsing engagement and investing in what makes our employees feel valued. Our pulse surveys provide us with data for leaders to use to ensure they are having the impact intended. This is one tool that should be used with a variety of tools to ensure we continue to understand each other regardless of role. These surveys allow us to have impactful conversations to gauge overall organizational wellbeing. Now that we are far more virtual than ever before, we must continue to create connectedness, check in with each other in a variety of ways and respond to the ever-changing climate of our work.

How has the pandemic impacted Human Resources professionals?

HR professionals have really had to stretch outside their comfort zones, beyond the predictable outcomes they are used to. What we’ve all seen happen over the last few years in our communities with regulations, politics, human behaviors and attitudes changing is also happening within organizations. We can’t build a policy to navigate it, we must lean in and care about it.

We have had to consider every perspective to make the right decisions for us as an employer, and to make the right recommendations for employees as one size does not fit all. While some organizations have used this as an opportunity to be defined by their policies, we’ve found that we’re too complex and dynamic to pick one side or another on many points related to the pandemic. The passionate people at Magellan Rx are navigating through every circumstance in the most caring way possible.

These last few years have impacted everyone. Leaders, managers and employees are recognizing the need to practice self-care first before care for others. I’ve been starting my day with MAGIC Mornings, which I’ve recoined for myself ‘Miracle Mornings,’ this practice affords me a margin of time to focus on myself and set my day through exercise, meditative prayer, affirmational writings, gratitude journaling and intention or goal setting. I’ve been doing this for four months now and have noticed a complete shift in how I approach and move throughout my day. I encourage teams and individuals to rethink how they start their days and prioritize their wellbeing to avoid burnout.

What’s your perspective on the Great Resignation?

My observation of what the data suggests is that people are reacting to what adds value to their lives. The notion of an employee leaving their job, and possibly their career, is changing attitudes and expectations. Employees have more of a voice than ever before in what they are willing to do, and not do, for a paycheck. We need to listen.

Do you think organizational culture plays a role in the Great Resignation?

Absolutely. For a long time, organizations have been trying to define an attractive culture with policies and programs like education reimbursement, wellness credits and unlimited PTO. What we are seeing during this Great Resignation is a shift in focusing on employee’s wellbeing and how they are treated. Cultures are formed by how leaders behave and employees feeling truly valued. It isn’t about a program; it’s about behavior.

What we’ve noticed at Magellan is that while our turnover rate has inched up, it isn’t at the national average, and we are still able to attract talent to our positions. We believe that this is a direct reflection of our strong culture of caring people who are leveraging their strengths in their everyday work and modeling positive behaviors.

What do you think is needed to create a thriving culture? 

First and foremost, authenticity and accountability from leaders. Then, you must focus on people because people make the difference. You do this by unlocking their strengths and unleashing their potential. Mix that with a little fun, and you’ve got a solid foundation to build a thriving culture.

Our secret sauce at Magellan Rx is that we don’t have a one size fits all strategy for any person. We start by focusing on an individual’s core strengths, which allows leaders and employees to deploy very tailored career development, growth performance and learning opportunities.

How do you think teams have remained resilient these last few years while some haven’t?

I think there is a lot of masked resiliencies happening right now – pushing through versus truly evolving through the challenges – which can be very dangerous because it means we are closer to burnout than we know.

You can tell resiliency is occurring when you are faced with the next challenge, and it energizes you because you learned from the last challenge and are able to use your learnings to evolve through the next obstacle.

For those that haven’t, do you have any advice?

There is no time like the present to pause and take inventory of all the things that you have pushed through, map those things to what you have learned, and really understand the impact of your work. When you are focused solely on what’s ahead and what’s not done, you deprive yourself the opportunity to pause and learn. Look back at the path you’ve laid and the wake you’ve made.

What should organizations do to invest in their people?
Create safe spaces and support systems for employees to stretch, learn and grow in their careers.

Think about their world, their environment and what they are trying to transform. Don’t forget to ask their opinion on what great looks like and listen, because at the end of the day it’s the people who make the difference in any organization.

Haita Makanji, vice president, clinical strategy and innovation supporting the specialty division of Magellan Rx Management, has worked for MRx for nearly 10 years, where she has focused on helping to support payers as they navigate the pharmacy space. Makanji, who is based out of Massachusetts, leads a team of highly trained pharmacists and experts in development and implementation of clinical solutions for customers in various high-cost specialty conditions across both the medical and pharmacy benefits including but not limited to cancer, hemophilia, and rare diseases. Her team focuses on utilization management, dose optimization, care management and technology-based programs for commercial, Medicare and Medicaid patients across the country. Continue reading to learn more about the innovative projects Makanji and her team are working on in the pharmacy space:

What sort of projects are you currently working on?

I’m passionate about working closely with payers and supporting them as they navigate the evolving landscape of new, expensive treatments, while also helping to deliver the highest quality of care to patients. For exceedingly high-cost specialty conditions, our emphasis is always on value through delivering clinical solutions that offer the most appropriate treatment to patients while combating the rising spend payers are facing.

For example, a recent project centers on a one-of-a-kind solution for payers focused on precision medicine in the oncology space, which is the highest-spend category for specialty drugs on the medical benefit for over 10 years. This is an exciting, next-generation pharmacy initiative where we will be combining genomic testing with drug selection for providers who treat cancer patients and meeting a critical need for payers who are looking for more complete solutions on both the medical and pharmacy benefit.

In 2021, we launched a comprehensive high-cost therapy program to provide enhanced utilization management strategies and case management referral for ultra-rare diseases. Payers often struggle to identify specialized experts, either internally or within their network, so our ability to leverage our MRx Expert Clinical Network of more than 175 key opinion leaders who practice various specialties, combined with our team of experts, offers a unique opportunity to support treatment decisions that leads to better health outcomes.

Why is Magellan the best place for these projects?

I’m proud to work for an organization that has a deep understanding of medical and pharmacy trends and a history of pioneering industry-first solutions for specialty drug management. With 17 years of experience in managing specialty conditions, we are unique in the marketplace.  Our customers routinely expand their collaborations with us because we continuously elevate our suite of solutions with innovative and forward-thinking approaches. Our mission is to help patients live healthy, vibrant lives and we accomplish this by ensuring that the right patients receive the right therapies at the right time.

What are your thoughts on the culture here at Magellan? How has that culture impacted your work?

We have a family-oriented culture where we collaborate and have a true understanding and trust of each other. Magellan fosters an environment that encourages open, honest feedback in all teams. Magellan also provides employees with the opportunity to challenge themselves and embrace new opportunities. This is imperative as we innovate and bring new programs to the market.

What exciting trends are you noticing in the healthcare industry? In what direction do you see healthcare going and what lessons are there to learn from other industries that can be applied to healthcare?

I’m energized by how quickly our industry is adapting to new technologies and advancements in the delivery of healthcare. Particularly in digital health solutions with the shift towards value-based care strategies and the pivot to personalized medicine.

The market will need to be laser-focused on providing clinically appropriate, personalized care at the lowest cost for both payers and patients.

One lesson we can take from other industries is the ability to be nimble and flexible. Disruptors in every sector of healthcare are bringing new offerings directly to consumers in the hopes that simplicity and transparency will cultivate consumer loyalty. We can take advantage of the availability of data and deployment of new technologies to respond quickly to changing market dynamics and the needs of our customers and their unique patient populations. While we have a proven track record and hundreds of successful case studies across our suite of solutions, it’s important that we never stop innovating!

In the midst of a national children’s mental health crisis, families are doing the best they can to assess how well their children are coping with increased stressors from the pandemic and figure out what to do if it seems they are having difficulty. Psychotropic medication is among the options to consider when indicated. However, over the years, children and adolescents with behavioral health challenges have generally been prescribed an alarming number of medications. This high prescription rate, paired with questions about the appropriateness of the diagnoses used to justify the drugs’ use, has raised many concerns among families, practitioners, and youth advocates alike. Prescribing medication to treat children’s mental health conditions can be appropriate, but parents, caregivers, and practitioners need to fully understand the risks and monitor their use.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Appropriate Use of Psychotropic Drugs in Children and Adolescents, which highlights evidence-based research on the use of psychotherapeutic agents in children and principles for optimal children’s psychopharmacotherapy practice.

Considerations for treatment with medication for children’s mental health

When families consider medication as an option to treat a child’s mental health condition, Magellan’s monograph offers the following to contemplate:

The practice of evidence-based medicine for children and adolescents requires health professionals and child welfare advocates to engage in a careful assessment of the risks and benefits of using psychopharmacological treatments while addressing serious concerns of over-diagnosis and overtreatment in this vulnerable population. As attention to these issues has grown, a strong undercurrent of anxiety and confusion exists about whether the use of psychotropic agents to remove undesirable impulses and behaviors of children may affect their neurological development, personality, character, and temperament. Suspicions exist that over-diagnosis and overtreatment are driven by a supply-induced demand created by pharmaceutical companies and medical providers.

Addressing the shortage of children’s mental health professionals

Another consideration for parents and families is the shortage of professionals providing specialized mental healthcare services for children. Mental healthcare for children is often initiated at the pediatrician’s office, Magellan’s monograph provides the following insights:

Given the significant national shortage of child psychiatrists, there remains a realistic need to rely on primary care clinicians to perform screenings of children for mental health disorders and treat uncomplicated ADHD, anxiety, or depression. However, the problem of follow-up care and ongoing monitoring of mental health problems in pediatric primary care is a matter that must be addressed.

Principles for optimal use of medication to treat children’s mental health

The American Academy of Child and Adolescent Psychiatry published the Practice Parameter on the Use of Psychotropic Medication in Children and Adolescents to promote the appropriate and safe use of medication to treat children’s mental health by emphasizing the best practice principles that underlie medication prescribing. These principles, as highlighted in the monograph, are as follows:

Principle 1: Before initiating pharmacotherapy, a psychiatric evaluation is completed.

Principle 2: Before initiating pharmacotherapy, a medical history is obtained, and a medical evaluation is considered when appropriate.

Principle 3: The prescriber is advised to communicate with other professionals involved with the child to obtain collateral history and set the stage for monitoring outcomes and side effects during the medication trial.

Principle 4: The prescriber develops a psychosocial and psychopharmacological treatment plan based on the best available evidence.

Principle 5: The prescriber develops a plan to monitor the patient, short and long-term. Clinicians should use standardized, objective measures to measure the efficacy of pharmacologic interventions.

Principle 6: Prescribers should be cautious when implementing a treatment plan that cannot be appropriately monitored.

Principle 7: The prescriber provides feedback about the diagnosis and educates the patient and family regarding the child’s disorder and the treatment and monitoring plan.

Principle 8: The child’s assent and parent’s consent are completed and documented before initiating, and at important points during, medication treatment

Principle 9: The assent and consent discussion is focused on the risks and benefits of the proposed and alternative treatments.

Principle 10: Medication trials are implemented using an adequate dose and for an adequate duration of treatment.

Principle 11: The prescriber reassesses the patient if the child does not respond to the initial medication trial as expected.

Principle 12: The prescriber needs a clear rationale for using medication combinations.

Principle 13: Discontinuing medication in children requires a specific plan.

We encourage you to learn more about medication to treat children’s mental health in the full clinical monograph and Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents, here. Both provide valuable insights and information to support the critical behavioral health needs of our nation’s children.

Do psilocybin, MDMA, LSD, ketamine, and cannabis sound familiar as medication therapy to help treat mental illness? It goes without saying that the pandemic has intensified mental health symptoms in the United States (US), turning an urgent matter into a crisis. One in 5 American adults suffers from mental illness, with young adults ages 18 to 25 years reporting the highest prevalence. These numbers speak volumes. Some treatment options do not adequately treat patients with mental illness and are associated with significant side effects. This underscores the need for more effective treatments. Because of these factors, psychedelics and other psychoactive substances are gaining momentum as possible alternatives.

Psychedelics are a “mind-manifesting” hallucinogenic class of psychoactive compounds that affect perception. They have been used by ancient civilizations for medicinal purposes and religious rituals for thousands of years. There is a renewed interest in using psychedelics to treat mental disorders driven by global research, influencers, education, and patient voices. Philanthropy has been the main funding source for psychedelics. However, a recent federal grant to Johns Hopkins Medicine to study psilocybin for tobacco addiction may signal a sea change in federal funding of psychedelic research.

While small-scale clinical trials have been promising, for psychedelics to become mainstream, large-scale randomized controlled trials are needed to fully evaluate their safety and efficacy. Studies are underway through several leading centers including MAPS – the Multidisciplinary Association for Psychedelic Studies – a non-profit dedicated to psychedelic research.

Psychedelics are not currently approved as prescription medications. Notably, the US Food and Drug Administration (FDA) has given Breakthrough Therapy designation to two psychedelics – MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD) and psilocybin-assisted therapy for treatment-resistant depression (TRD) and major depressive disorder (MDD). FDA’s Breakthrough Therapy is designed to “expedite the development and review of drugs which may demonstrate substantial improvement over available therapy.” As clinical trials progress, 2023 could bring regulatory approval for the MAPS’ MDMA-assisted psychotherapy for PTSD, a potential turning point in the mental health treatment paradigm.

Patients with mental health illnesses deserve to heal and restore balance to their lives without stigma and judgment and deserve treatments that are safe and efficacious. Step into Magellan’s Clinical Insights for the role of psychedelics in treating mental health conditions. This industry-first paper explores the current evidence, regulatory, and legislative landscape for psychedelics and shares Magellan’s four pillars on emerging therapeutic frontiers. We are guided by four principles:

• Education and thought leadership for patients, payers, providers, and stakeholders while addressing the stigma around mental health
• Evidence-based clinical recommendations and coverage
• Patient safety by advocating for quality standards
• Access that is responsible and sustainable

Disclaimer: The content in this blog article is not a substitute for professional medical advice. For questions regarding any medical condition or if you need medical advice, please contact your healthcare provider.

For Greg Dicharry, his work at Magellan Healthcare is not just a job, it’s a passion. Filming and directing documentaries highlighting suicide awareness has been a welcome side gig of Dicharry’s job as national youth empowerment director at Magellan. For the past 14 years, Dicharry has been connecting with people affected in some way by suicide, substance use and other mental health concerns. From those experiences, he launched the MY LIFE (Magellan Youth Leaders Inspiring Future Empowerment) program. MY LIFE provides various activities and workshops for youths ages 13 to 23-year-olds nationally who have experience with mental health, substance use, juvenile justice or foster care-related issues or have a friend or family member coping with these issues. Dicharry’s latest documentary project, “My Ascension,” shows the crippling effects suicide can have on families while telling the captivating personal story of a suicide survivor. Continue reading to learn more about the MY LIFE program and Dicharry’s upcoming documentary.

What sort of projects are you currently working on?

My main responsibility at Magellan is overseeing our MY LIFE program, which we created in 2008 as part of our Maricopa County, Arizona contract. Since 2008, MY LIFE has been leading the way nationally for youth involved in behavioral health and foster care systems. Through regular meetings, special events, performances, social media, and local and national presentations, youth share their stories and support each other in their recovery goals. In response to the COVID-19 pandemic, Magellan launched the Stay Home for MY LIFE virtual youth fest series in 2020. I also do a lot around suicide prevention for the Company and am a part of the new Suicide Center of Excellence. In my spare time, I create documentaries. Over the last three years I’ve been working on a documentary called “My Ascension.” Prior to that I had done another documentary called “Suicide: The Ripple Effect” but this new one is on teen suicide. I made it with a young lady who is a suicide attempt survivor. She attempted to take her life by gunshot and the result was that she is now paralyzed. She had this rebirth through that and now uses her experience to help others via speaking and advocacy, so the story is largely her story but also of other young people in the community who were successful in their suicide attempts and the aftermath of how that has affected their families.

“My Ascension” will premiere nationally on PBS (Public Broadcasting Service) in September. The primary distribution method has been virtual community screening around the country. We’ve done screenings with a couple of universities and several advocacy and mental health groups.

What inspires you to create these documentaries?

I dabbled in film and media throughout high school and college. When I moved to Los Angeles I started working on projects like movies, award shows, commercials and music videos and learning that way.

With the MY LIFE program, I had gotten a camera through Magellan and was able to start producing videos with the youth group so that got me back into filming and then I met a man through work, who’s a suicide attempt survivor, we became friends and he approached me wanting to make a documentary and I helped him with producing and directing. I didn’t plan on doing another documentary, but the opportunity came to tell this very compelling story for “My Ascension” that could reach a lot of young people and empower them in helping them to share their stories.

I also have a personal connection to this where I’ve found myself struggling with suicidal thoughts, and my cousin who was bipolar with a substance abuse issue and died by suicide about 20 years ago. I saw the impact that had on his family and that inspired me to be interested in the topic.

Why is Magellan the best place to do this project?

Magellan is open to innovation, even though it’s a big company everyone is open to new ideas to help better serve our members and customers. For example, with MY LIFE I came up with the idea to do this, it wasn’t something that was a part of my job description or something Magellan had ever done. But they let me run with it and it was successful. People saw the value of it and saw that the opportunity to serve our members and provide them with something in a different way.

With the documentaries, my job had allowed me to be able to do that kind of stuff on the side and it ended up being another way to connect with people differently way and blend the work I’m doing here.

What are your thoughts on the culture here at Magellan? How has the culture at Magellan impacted your project?

It’s a culture that’s open to innovation and that’s open for doing unique things that are engaging for our customers. It’s very supportive, encouraging, and positive work happening here.

• Learn more about MY LIFE here.

Finding the best strategies to achieve good outcomes is one of the many goals of Tim Daley. As vice president of network development Tim’s two main responsibilities include network optimization and value-based contracting strategies. By working closely with providers to define a high-quality experience for members, Daley aims to create a more efficient member journey that creates excellent outcomes. According to Tim, leveraging Magellan Healthcare’s experience and expertise in behavioral health will help strengthen provider partnerships. Read more below on how Daley manages network optimization and value-based programming:

What are some projects you’re currently working on?

I’m very excited about our work on network optimization. We have a large national network, with members also spread out across the country, which has been developed over decades. It was time to assess our networks in terms of access, availability, quality, and outcomes relative to the varying needs of our members. We currently share actionable insights with providers via our new provider partnerships team. Ultimately, a high performing network that meets the unique needs of individuals will lead to better outcomes and lower overall costs for everyone.

On the value-based programs side, my role is to ensure Magellan designs and implements programs that achieve better results under alternative payment models compared to fee-for-service. Magellan has a long history of partnering with facilities on value-based contracts, and now we’re doing the same with out-patient providers.  For example, a provider may see a patient for 45-minutes, and they want to be paid a certain amount for that session, which could lead to a “the more sessions I do, the more I’ll get paid” mindset. Is that driven by the payment model or is that driven by the best experience for the member? There are several “disruptors” emerging in the behavioral health space, and I’m proud to say I am leading the charge on network inclusion while contracting in ways that ensure provider incentives are aligned with improved outcomes.

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

I don’t think there’s anybody out there with more full-spectrum behavioral health experience than Magellan. We’re focused every day on patients having a good outcome, a good experience, and how the care delivery model may require a little more care coordination or engagement at the time of transition.

Implementing true partnerships with our provider community is not just the network team’s role, but a cohesive approach that spans across all departments within Magellan. Therefore, our people, their experiences and commitments to making a difference in people’s lives, are the strongest asset we have as an organization.

What are your thoughts on how the culture is here at Magellan Health?

We’ve gone through a change over the past year with offices closing and a lot of people having to work from home, but I’ve seen almost everyone embrace that change. There’s a real commitment here to what we do. I’ve talked with many other employees who have had their own connection to someone dealing with a behavioral health issue, many of which were exacerbated by the pandemic. So many of us have dealt with a behavioral health experience so we know what a good outcome feels like because we’ve lived through it personally. We need to continue to translate that into what we do day-to-day here.

How does the culture at Magellan Health impact the projects you’re working on?

The personal experience and culture that everyone here brings and the dedication to this work despite challenges help everyone to be driven to do the right thing. We need to continue to move in that direction, tackling the larger issues and prioritizing energy on what makes a difference. If we can do that, then not only will Magellan succeed but patients will truly be the winner.

What direction do you see the healthcare industry going in?

I think behavioral healthcare needs have become more of a focus during and coming out of the pandemic; over the past year it’s become much more of a focus. It really is all about people. Everybody’s got something going on and we must look at the mind and the body one. When you put that together with the physical health side of things, I think we can do well by people.