Magellan Healthcare is a proud supporter of BIPOC Mental Health Awareness Month in July. BIPOC is an acronym for Black, Indigenous and People of Color that aims to empower groups formerly identified as “minority” or “marginalized.”

In this post, we’ll discuss BIPOC mental health and barriers to care. You can learn more by watching a recording of our webinar, “Navigating mental healthcare: Unique challenges faced by the BIPOC community,” here.

Prevalence of mental health conditions among BIPOC communities

BIPOC face unique stressors that increase mental health vulnerability. Racism and discrimination are consistently found to be associated with poorer mental health.[1]

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the prevalence of mental health conditions among BIPOC:[2]

BIPOC adults (prevalence of any mental health condition)

• 32% Two or more races
• 19% American Indian and Alaska Native
• 18% Hispanic or Latinx
• 17% Black or African American
• 17% Native Hawaiian and Other Pacific Islanders
• 14% Asian American

BIPOC youth (prevalence of depression)

• 21% Two or more races
• 17% Hispanic or Latinx
• 15% Asian American
• 12% American Indian and Alaska Native
• 11% Black or African American
• (data not available) Native Hawaiian and Other Pacific Islanders

Barriers for BIPOC in accessing mental healthcare

BIPOC are less likely to receive treatment for mental health or substance use conditions.[2] In 2020, 5.7% of Asian Americans, 9.4% of Black people or African Americans, and 10.7% of Hispanic or Latinx people received mental health services, compared to 21% of White people.[2]

Research indicates, compared with people who are White, people in BIPOC communities are:[3]

• Less likely to have access to mental health services
• Less likely to seek out treatment
• More likely to receive low or poor quality of care
• More likely to end services early

Several factors contribute to BIPOC being less likely to receive treatment for mental health or substance use conditions, including a lack of insurance or underinsurance, mental illness stigma, language barriers and distrust in the healthcare system.[4]

Increasing awareness of the issues people of color and those in marginalized communities face helps reduce stigma so those with mental health concerns can get the help they need to thrive in their lives.

On July 20 Magellan Healthcare hosted a webinar, “Navigating mental healthcare: Unique challenges faced by the BIPOC community,” for BIPOC Mental Health Awareness Month. Watch a recording of the webinar as we explore different roles in behavioral healthcare and overcoming stigma to help BIPOC feel more knowledgeable and comfortable about reaching out for help: https://www.magellanhealthcare.com/event/navigating-mental-healthcare/.

[1] “Racism as a Determinant of Health: A Systematic Review and Meta-Analysis”, “Self-Reported Experiences of Discrimination and Health: Scientific Advances, Ongoing Controversies, and Emerging Issues”, “Discrimination and Subsequent Mental Health, Substance Use, and Well-being in Young Adults”

[2] SAMHSA 2020 National Survey of Drug Use and Health Adult and Youth Mental Health Tables

[3] Counseling Today, “The historical roots of racial disparities in the mental health system”

[4] American Psychiatric Association, “Mental Health Disparities: Diverse Populations”

“Our obligation to act is not just medical—it’s moral.”
Vivek H. Murthy, M.D., M.B.A. Vice Admiral, U.S. Public Health Service, Surgeon General of the United States

To support the Surgeon General’s recent advisory related to protecting youth mental health issues exposed by the COVID-19 pandemic, Magellan Federal offers best practices for professionals specializing in behavioral issues to foster the wellbeing of our military families.

Magellan Federal directly supports the mental health and resiliency of military youth and families, serving over 4.5 million service members and families a year. Read more about risk factors and recommendations in our whitepaper here.

Stacy Drones’, senior director of family programs at Magellan Federal, passion for helping military families comes from her real-life role as a military spouse. Since joining Magellan Federal in 2013, Drones now supervises a large array of military family programs including the Army Family Advocacy Support Services which includes the Domestic Abuse Victim Advocacy Program and New Parent Support Program, Army Exceptional Family Member Program and the Air Force Family Advocacy Program contracts. Drones is currently working on initiating various trainings for employees to better help the military families they serve in their unique situations. Continue reading to learn more about the many projects happening at Magellan Federal during Military Appreciation Month this May:

What can you tell us about Magellan Federal?

Magellan Federal has a strong history of support to the military. A lot of our employees on our contracts are military spouses, former military spouses or veterans who are passionate about the work. Many of our leaders at Magellan Federal have been in some way connected to the military, this is important and shows we have a passion for the work that we do because of our connection with service members and their families. My team has historical knowledge of our programs and we’ve been working with the government clients for a long time and know what they’re looking for and know how to execute the contracts successfully in the programs.

What cool, innovative projects are you currently working on?

The main part of my job involves managing our portfolio of programs that support military families. I personally manage the Family Advocacy Support Services contract for the Army which includes the Army Domestic Abuse Victim Advocacy Program that provides services for victims of domestic abuse. This contract also includes the New Parent Support Program that offers home visits to provide help and educational resources for new parents. This program provides licensed clinical social workers, marriage and family therapists and registered nurses to work with military families with children who are newborn up to age three. They conduct regular home visits to offer education that helps to prevent child abuse. We also have a lactation contract with the U.S. Food and Drug Administration that hosts monthly lunch seminars for mothers who are nursing. In addition, we serve as a subcontractor for a family advocacy program at Food Hood where we provide information on stress management, parenting, couples communication, relationship classes and domestic abuse. I also oversee other contracts assigned to other program managers like the Army Exceptional Family Members Program, that provides help to military families who have dependents with disabilities and connects them with referrals and resources in the community. There’s also the Air Force Advocacy contract that we’re a subcontractor on that provides domestic abuse advocates for members of the Air Force.

On the Family Advocacy side, we do at least two employee professional development trainings a year. Planning those trainings and brining in speakers from all over is our big focus right now. Government employees are welcome to participate as well. We also have a requirement to have all victim advocates credentialed through the National Advocacy Credentialing Program. Although this is a new government requirement, Magellan has had this requirement in place for our Victim Advocates for nine years. We are currently helping our government client roll this training out to the government Victim Advocates.

In the New Parent Support Program, we are currently training our home visitors on how to address sensitive topics with their clients, such as mental health, abuse and race. They’re also trained on how to help parents and caregivers deal with the unexpected, such as deployments, birth plan changes or giving birth to multiples.

What are your thoughts on Magellan’s culture? How has the culture impacted your projects?

I love this company and the leadership; I think they’re very supportive of what we do. I feel that Magellan’s leadership really cares for their employees and cares about what we’re doing and how we’re doing it.

What trends are you noticing in the healthcare industry that are related to the work being done at Magellan Federal? Are there any lessons from other industries that can be applied to the work happening at Magellan Federal?

A big focus of the DoD Family Advocacy Programs currently is working with families of problematic sexual behaviors in children and youth. We have been looking at ways to intervene early and provide help for those children who are presenting those behaviors. We have our home visitors involved with this because they’re the ones working with the families in the home and have built a rapport with them. We’re increasing training for our home visitors to ensure they know the best way to help provide services to those families. The military has partnered with a lot of civilian agencies to provide trainings to help figure out how to address and solve the problem.

Magellan Federal understands that military families may have unique challenges compared to civilian families. That’s why we are doing what we can to develop partnerships with civilian agencies that have the funding to do research and develop correct programs. Initially, the development of the new Federal Program Management Office has been great for developing relationships with organizations. If we continue to do that, it’ll be a great thing.

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

What a year it’s been for relapsed refractory multiple myeloma (RRMM)!!  The year has already ushered in an FDA approval of a second CAR-T therapy, Carvykti™ (ciltacabtagene autoleucel, cilta-cel), in February!  Last year we saw the approval of the first RRMM CAR-T therapy, Abecma® (idecabtagene vicleucel, ide-cel). Both are approved as a single dose after at least 4 lines of therapy, with many patients enrolled in each pivotal trial having received a median of 6 or more lines of therapy.

The FDA approval and NCCN 2A recommendation for both drugs is for patients who failed prior treatment with an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent. In the ide-cel trial, 92% of patients had received prior autologous stem cell transplant while in the cita-cel trial, 90% of patients had received prior autologous stem cell transplant and, of note, 8% had received a prior allogeneic stem cell transplant. Unfortunately, RRMM has no known cure for heavily pre-treated patients. That being said,  B-cell maturation agent-directed CAR-T cell therapies reported high response rates (ide-cel:  72% ORR [28% sCR; 25% VGPR]; cilta-cel: 97.9% ORR [78.4% sCR; 16.5% VGPR]) which were durable (median DOR: ide-cel 11 months; cilta-cel 21.8 months).

MM is largely a disease of the elderly with a median age of diagnosis being 69 years. In 2018, an estimated 149,956 Americans were living with MM.  The rate of new multiple myeloma cases is trending up, with an estimated 34,920 new cases diagnosed in 2021 (1.8% of all new cancer cases) and a projected 2,410 deaths.  Even though relative 5-year survival has increased over time, it has been 55.6% from 2011-2017.

Concerns around the monetary cost of CAR-T therapy continue.  Even though CAR-T therapy demonstrates high response rates and carry the hope of a sustained, durable response, how long will response last? What treatment(s) will follow?

CAR-T therapy is a single dose, with a significant high monetary cost. The medication wholesale acquisition price for ide-cel and cilta-cel is $419,500 and $465,000 respectively. In addition, the time to product availability and rate of manufacturer product failure remains a concern (ide-cel median availability of 33 days with a 1.5% failure rate; cilta-cel median availability of 32 days with an 18% failure rate). Another hurdle is the shortage of the lentiviral vectors used to deliver ide-cel. However, the manufacturer is working to increase production.  For cilta-cel, the manufacturer plans to make vectors in-house in order to meet longer-term demand.

A forecasted cost impact model is demonstrated below. With more than 8 CAR-T drugs in the pipeline for multiple myeloma, more for hematologic cancers, and the possible expansion from hematologic to solid tumor treatment, more contemplation is sure to follow.

References:

1. Martin T, Usman SZ, Berdeja JG, et al. Updated Results from CARTITUDE-1: Phase 1b/2Study of Ciltacabtagene Autoleucel, a B-Cell Maturation Antigen–Directed Chimeric Antigen Receptor T Cell Therapy, in Patients With Relapsed/Refractory Multiple Myeloma. ASH update 12 December 2021. https://ash.confex.com/ash/2021/webprogram/Paper146060.html. Accessed April 12, 2022.
2. Berdeja JB, Madduri D, Usmani SZ, et al. Ciltacabtagene autoleucel, a B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in patients with relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b/2 open-label study. Lancet. 2021;398(10297):314-324 doi: 10.1016/S0140-6736(21)00933-8.
3. Carvykti [package insert]. Horsham, PA; Janssen; March 2022
4. Abecma [package insert]. Summit, NJ; Celgene; March 2021.
5. Munshi NC, Anderson LD Jr, Shah N, et al. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma. N Engl J Med 2021;384:705-16. DOI: 10.1056 /NEJMoa2024850.
6. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Myeloma. Available at: https://seer.cancer.gov/statfacts/html/mulmy.html. Accessed April 12, 2022.
7. Kanas, G, Clark O, Keeven, K et al. Population-level Projections for Multiple Myeloma Patients by Line of Therapy in the USA. Poster No. 653 | Presented at the 62nd American Society of Hematology Annual Meeting and Exposition (Virtual Format) | December 5–8, 2020. https://d201nm4szfwn7c.cloudfront.net/5f95dbd7-245e-4e65-9f36-1a99e28e5bba/5b3ee4c1-c770-4504-9d91-08c64ae7bcc6/5b3ee4c1-c770-4504-9d91-08c64ae7bcc6_viewable_rendition__v.pdf?medcommid=REF–ALL-003261. Accessed 4-12-22.
8. Liu A. Johnson & Johnson, Legend’s CAR-T Carvykti enters myeloma ring with FDA nod. Fierce Pharma. Johnson & Johnson, Legend’s CAR-T Carvykti enters myeloma ring with FDA nod | Fierce Pharma. Accessed April 14, 2022
9. Osterweil N. Novel CAR T Therapy for Solid Tumors: ‘Exciting Advance’. 2022. https://www.medscape.com/viewarticle/972297. Accessed 4-19-22.

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.

Magellan Federal honors military caregiving children through a commitment to Hidden Helpers Coalition

Military Appreciation Month is celebrated in May and is a special month for those in and out of uniform. Throughout the month we celebrate Memorial Day (May 30), Military Spouse Appreciation Day (May 6), and Armed Forces Day (May 21). But did you know that it is also Month of the Military Caregiver?

Month of the Military Caregiver

The Month of the Military honors more than five million self-identified caregivers in the United States. By observing Military Caregivers, we can raise awareness and support for both wounded warriors and the people who care for them. Many of those caregivers are children, who have largely been unrecognized and unsupported—until now.

Honoring Military Caregiving Children

There are 2.3 million children of injured, ill, and wounded service members and veterans who play a crucial role in caring for their loved ones.

Magellan Federal has joined the Elizabeth Dole Foundation’s Hidden Helpers Coalition, a group of more than 60 organizations committed to recognizing the service of military caregiving kids and enhancing support services available to them. As a Coalition member, we have pledged to engage our nation’s health care providers to create a new national model of support for caregiver children within medical institutions to ensure that the physicians, nurses, and mental health and allied health professionals better understand and address the unique challenges military children face at every stage of their development.

Through the work of targeted sub-committees, the goal of the Hidden Helpers Coalition is to create a comprehensive framework of best practices, impactful tools, and action steps focused on supporting the overall well-being and long-term positive outcomes of Hidden Helpers and their families. Through this holistic approach, the coalition will develop baseline best practices for the ecological systems that impact Hidden Helpers.

This commitment reinforces what we do here every day at Magellan Federal — supporting the behavioral health of military service members, veterans, civil servants, and their families — and is just one example of how we give back to the military community beyond our everyday work.

If you or your organization is interested in supporting military caregivers, I encourage you to stand with us to make a difference by reading more at Hiddenheros.org 

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: