As vice president of clinical products and solutions, Ashley Rutter is focused on all things related to specialty products and specialty strategy at Magellan Healthcare – from working on projects like genetic testing and sleep solutions, to developing innovative ways to improve the provider experience. Based out of the Washington DC metro area, Rutter has been with Magellan for five years. Through innovation with developing specialty products, Rutter aims to create solutions that ensure high quality and appropriateness of care in complex specialty areas. Continue reading to learn more about the specialty products Rutter is working on, along with her thoughts on how Magellan’s culture has had a positive impact on bringing those products to fruition.

What projects are you currently working on?

Our product team is focused on developing new verticals in the specialty management space, one of which is genetic testing. Magellan is working with an organization to develop a comprehensive genetic testing solution that includes medical policies, payment integrity solutions, a preferred laboratory program and a utilization management component to cross the entire spectrum of genetic testing. This solution will ensure that the right tests are ordered at the right time and are billed appropriately.

In addition, we are also very focused on leveraging technology and artificial intelligence to drive efficiencies to maximize value for all stakeholders including members, providers, and payers. For example, we are developing solutions to automate the prior authorization process at the point-of-care to reduce the administrative burden on providers.

When we think about the future state of specialty products, we know that there is a tremendous spend across complex conditions such as oncology, musculoskeletal and cardiovascular disease. We have the clinical expertise and experience to be able to make a meaningful impact across those complex and high spend areas. Therefore, the time is right to look beyond utilization management to ensure we’re offering solutions that keep the member at the center of the treatment plan that is designed to support end-to-end management of that condition or episode.

Why is Magellan the best place to do these projects?

We have extensive capabilities and subject matter expertise across our business segments that support innovation. I also think that our clinical expertise is unparalleled, and we have tremendous support from clinical champions across the organization to drive new solutions. In addition, we have strong collaborations in place with some of the most cutting-edge companies in the industry who help to support innovation.

What are your thoughts on the culture at Magellan and how does that culture impact your projects?

The Magellan culture has supported the work that I’m doing with my team by really offering support and expertise given the diversity of experience that folks have within the organization that we can look to when developing new solutions.

The variety of business units across Magellan lends itself to a culture that supports tremendous professional development opportunities. I’ve had the opportunity to work either directly with or get exposure to all segments across Magellan, including specialty, behavioral, pharmacy, and federal and I’ve learned so much from each part of the organization. Magellan is full of mission-driven and incredibly hardworking people with expertise from all over the industry, this really supports a collaborative culture where folks are always learning from one another.

What are some exciting trends in the healthcare industry that you’ve noticed? Based on those trends, in what direction do you see the healthcare industry going in? What lessons are there to learn in other industries that could be applied to healthcare?

Every single person in this country engages with healthcare at some point in time. While the ways that folks engage continues to evolve, the opportunities to improve those experiences are plentiful.  First, digital transformation is incredibly exciting because there is so much opportunity to fundamentally improve the way that healthcare is delivered. By automating systems and processes, we can maximize value for members while driving value across the entire healthcare delivery system. Digital transformation also has the potential to empower healthcare organizations with the data to be able to best serve their members and reduce the administrative burden on providers to allow them to stay focused on treating members.

Virtual care is another trend that has gained so much momentum over the last couple of years with COVID as a catalyst. We can learn so much about member engagement in this new way that care is being delivered. As we think about more comprehensive condition management, we need to be able to leverage some of those best-in-class virtual solutions to meet numbers where they are and deliver the very best care that we possibly can.

Finally, value-based care is an important trend that we must keep front and center of any new solutions on which we are working. We know that we have a tremendous opportunity to supply providers with tools and data to understand the quality of care they are providing to those members. We’re looking forward to continuing to innovate in that space to effectively collaborate with providers on managing the highest cost and most complex conditions and services.

Twenty twenty-two is here, with all its possibilities and opportunities. You may be wondering how you will achieve all of your personal and professional goals this year. Your mental health in 2022 may hold the key to success. Read on for tips from Magellan Healthcare’s behavioral health experts to help you prioritize your mental health in the new year.

1. Spread out New Year’s resolutions over the year – At the beginning of the year, people usually try to accomplish too many resolutions all at once. They are quickly overwhelmed and give up. Instead, create a list of resolutions, or goals, to implement–one per month–over the year. Spreading out goals and focusing on one at a time will feel more consistent with lifestyle change than the usual New Year’s start and stop. – Candice Tate, MD, MBA
2. Plan things to look forward to – Having a daily routine is important for our mental health. It limits the chaos and helps us feel grounded. But it can get boring, especially during COVID-19 when we are closed in. Schedule things to look forward to for the upcoming weeks and months. Maybe schedule a day trip on a weekend, a few hours in the evening to watch a movie, or a phone/Zoom call with an old friend, make a reservation at your favorite restaurant or plan to place a delivery order. Choose things that make you feel good. – Linda Evans, MD, FAPA
3. Limit screen time and media exposure – Social media has been a much needed lifeline for so many of us during the pandemic, but it’s essential that we remember to limit our screen time and exposure to content that can be emotionally distressing or traumatizing. Make a habit of putting your mobile device down and stepping away from your computer to enjoy the people, plants or pets in your environment. Go outside, take a walk, and get some fresh air and sunlight. – Rakel Beall-Wilkins, MD, MPH
4. Learn that “no” is a complete sentence – You cannot pour from an empty cup. Saying yes to every request asked of you when you are already limited on time, energy or resources can increase stress levels. Putting your needs on the backburner is not healthy for you. Being a “yes” person sometimes equates to saying “no” to your own mental health. Recognize not only when to say no, but that you don’t have to feel guilty about it… It’s all about saying yes to you! – LaShondra Washington, MD, DFAPA
5. Measure something – Our perceptions often do not match the reality of a situation but picking something to measure that is related to a concern can help better align our perceptions to reality. And if the results of the measurements indicate that indeed perception and reality are aligned, then continued measurement, after an intervention, can determine the usefulness of the intervention on the measure. In other words, take steps to find out if what is bothering you is really a problem, and if it is, then make a change and reassess. – Louis Parrott, MD, PhD
6. Engage in journaling – Journaling is an effective way to manage stress and feelings. It can be cathartic to write about feelings and experiences. It is also a way to monitor your inner self and when it may be necessary to seek professional help. – Samuel Williams, MD, MBA, FAPA
7. Practice gratitude – Share gratitude with others and write three things you are grateful for every day. According to Jon Kabat-Zinn, PhD, an internationally known mindfulness advocate, we should ask ourselves three questions each day that relate to our relationships with family, friends, and co-workers: What have I received from __? What have I given to __? What troubles and difficulties have I caused? – Doris Lebischak, MD
8. Establish an attainable plan for regular physical activity and stick to it – Start with one or two days of exercise a week. Plan the days, times, and activities and commit to making it happen. Exercise is proven to reduce depression, anxiety, and negative mood.[1] – Greg Dicharry, CPRP
9. Consider expanding your exercise routine – As we age, our muscles must be challenged to maintain strength. Including strength training, stretching and physical activity that raises the heart rate in our workouts will have an immediate impact as well as long-term benefits for the body and mind. – Paula Hensley, MD
10. Eat a balanced diet with as many unprocessed foods as possible – Include colorful fruits and vegetables and prepare food in healthier ways like steaming and roasting rather than frying. If applicable, include children in meal selection and preparation, and eat at least one meal per day as a family. Try not to place food into strict bad and good categories, and understand that you are not–accordingly–bad or good depending on what you eat. It’s important to eat a balanced diet for your lifestyle. – Misty Tu, MD
11. Prioritize sleep – Push through busy schedules and life’s distractions to maintain eight hours of sleep each night and experience how it helps you think more clearly, feel better and be better able to creatively juggle the multiple demands of family, work, and beyond. – Barbara Dunn, LCSW, ACSW
12. Develop a cue that ends your workday – Whether it is pausing to watch the sunset, moving your body for 20 minutes, or ceremonially closing the door to your workspace, disconnecting from work to focus on rest, joy, or family responsibilities is a necessary way to prioritize mental health in 2022. – Dana Foglesong, MSW, NCPS, CRPS
13. Make sure to prioritize yourself – In a time when kids are home, work is piling up, and there is growing uncertainty in and outside of our homes, it’s unfortunately easy to get lost in all we have going on. But it’s vital we prioritize ourselves. Whether it’s going on a walk or other exercise, meditation, talk therapy, weekly dinner with friends or family… don’t ever forget to put yourself first because your mental health is wealth. – Yagnesh Vadgama, BCBA
14. Ask for help when you need it – Recognize that no one person can do everything. Family, friends, and neighbors can be great resources, so ask for what you need and offer help to them when you can. – Kathryn Kvederis, MD, DFAPA
15. Remember that you are not alone – One in five American adults has a mental illness and one in 18 American adults has a serious mental illness; one in six American youth has been diagnosed with depression.[2] Despite all of the glittery images we may see and our perceptions that others have it better, it’s likely that we have family members, friends, and co-workers who are right there with us when we aren’t feeling our best. – Keith Brown, MD

As we sail into a bright new year, with 2021 in the rear-view mirror, let’s remember to prioritize ourselves and our mental health. We have all experienced the trials and tribulations of a tumultuous previous two years. If we have learned anything, it’s that our mental health in 2022 is what will keep us strong and poised for happiness and success.

Visit MagellanHealthcare.com/BH-Resources for free information and tools to address mental/behavioral health needs and spread awareness to reduce stigma. Stay tuned here and on our calendar for updates on our virtual events throughout the year.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/

[2] https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases

We made it through Thanksgiving – hopefully emotionally unscathed. But for many, managing mental health during the holidays is not easy. Whether you deal with anxiety for months leading up to the holiday, your family is plagued with arguments or more subtle discomfort during get-togethers, and/or you are mourning the loss of a loved one and have an empty seat at the table – the holidays can be tough. In fact, in a 2021 survey, 44% of Americans said that preparing for the holidays is stressful and 39% said that family gatherings during the holidays are stressful.[1]

Holiday anxiety

Anxiety is defined by the National Institutes of Health as “a feeling of fear, dread, and uneasiness.”[2] And why might we feel anxious leading up to what one might consider a wonderous and magical occasion, such as Thanksgiving or a December holiday, with our family? The reasons are endless. It could be a difficult family member we are not looking forward to seeing. It could be that we are not feeling particularly good about ourselves and want to face others. Maybe we are hosting a holiday gathering and worried about getting everything done in time, how much everything will cost and whether everyone will have a good time.

We are barraged with media images of what the perfect holiday looks like, and we may sometimes feel pressure to be happy and festive and live up to expectations.

When we dread an upcoming holiday, it puts a damper on more than merely just that day or specific gathering, but the days, weeks, or even months leading up to it. It is almost like the reverse of excitement or anticipation. But whether we are excited or anxious about something, the actual event often does not live up to our expectations. In the case of holiday anxiety, if we can remember that it may actually end up being better than we think and simply try not to care as much, our anxiety time may be reduced. We can let go of others’ expectations of us and do what truly makes us happy.

Family arguments during the holidays

Yes, most families argue – even during the shiny holidays and behind the scenes of the happy pictures we post on social media. And just when our typical bickering was not enough, our country has become increasingly divided, and it has seeped into our very own families. There are things we can do to prevent the arguments and deal with them in a healthier way when they occur.

You have probably heard the phrase “communication is key.” A lot has changed over the past couple of years and continues to change at a rapid pace. We may think we know how a loved one would like to celebrate the holidays, for example. But their preferences, and our own, may have changed just like so much else has changed.

It’s a good idea to initiate respectful conversations – early in the holiday planning process – with our family and friends to understand where they are coming from on certain issues. It can be a way to identify the topics that should be off-limits during the upcoming holiday gathering and prevent arguments.

During these early conversations and when we’re all together for the holidays, our family members may inevitably do or say something that rubs us the wrong way. At that moment, our reaction will set the course for what comes next. As our feelings come together to form that reaction, why not assume goodwill and the best intentions of the offending person. It may be that their actions and comments reflect the way they feel about themselves and not the way they feel about you.

With so much to disagree about these days, there is also a lot we can agree on. Try to focus on the latter, agree to disagree when possible, and assume that others are coming from a place that is genuinely meaningful to them.

Grief and missing a loved one during the holidays

The pandemic has taken so much from us, including the lives of precious loved ones. The holidays have always been a difficult time to bear when we cannot share them with a lost family member or friend. During this holiday season, you can uphold and honor memories of those you have lost in many ways: Look through photographs of the person and reminisce about holidays of the past; do things you used to do with a lost loved one during the holidays, like cooking or baking a certain recipe, a craft, or decorating; and journaling or talking with others about your feelings.

It can be hard to move on without a person we love, but they would want you to be happy. We will always have their memories during the holidays and beyond, as we carry on with old and new traditions.

We can all agree that it has been another tough year. But we have endured, and it is time to let go of expectations and focus on our mental health during the holidays and how the holidays can be a time to do what makes us happy, spend quality time with those who are important to us and cherish the memories of those we have lost.

Visit MagellanHealthcare.com/Holidays for additional information and resources on holiday emotional wellbeing and how to find peace and moments of joy with family and friends this holiday season.

[1] Collage Group Holidays and Occasions Survey, May 2021

[2] https://medlineplus.gov/anxiety.html

Candice Tate, MD, MBA, serves as a medical director at Magellan Healthcare. Dr. Tate’s treatment philosophy includes a strong physician-patient therapeutic alliance and safe, responsible medication management. Dr. Tate joined Magellan in 2017. She has years of experience in psychotropic medication management for a variety of psychiatric conditions in inpatient and outpatient settings. During her graduate medical training, Dr. Tate was extensively trained in psychodynamic psychotherapy and was supervised by experienced psychoanalysts. She is also familiar with cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and dialectical behavior therapy (DBT). Dr. Tate graduated from the University of Tennessee Medical School in Memphis and completed her graduate medical education in General Psychiatry at Northwestern University’s Feinberg School of Medicine in Chicago, IL. Dr. Tate is a board-certified psychiatrist by the American Board of Psychiatry and Neurology.

The holidays can be a joyous time—a time to spend with family and friends, reflect, and be thankful. Yet, for many people, the holiday season can bring on the blues, including feelings of anxiety, stress, worry, and sadness. These feelings may even be worse for those who have experienced divorce, lost a loved one, or are living far away from family and friends.

The holiday blues

A 2014 survey conducted by the National Alliance on Mental Illness (NAMI) found that the holidays contribute to feelings of sadness or dissatisfaction. Of those surveyed:

• 63% reported there was too much pressure
• 57% stated they had unrealistic expectations
• 66% reported experiencing loneliness
• 50% were unable to be with loved ones
• 55% found themselves remembering happier times in the past contrasting with the present
• 68% reported feeling financially strained

While the holiday blues are different from mental illness, it can lead to clinical anxiety and depression. It is important that we do not ignore these feelings, especially as we all continue to deal with changes wrought by the COVID-19 pandemic but deal with them in a proactive and healthy manner.

Tips for beating the holiday blues

1. Throw guilt out the window. Try not to put unreasonable pressure on yourself to be happy or enjoy the holidays and avoid overanalyzing your interactions with others. Give yourself an emotional and mental break this holiday season.
2. Be realistic and try not to expect the “ideal” holiday. Keep expectations for the holiday season manageable by not trying to make the holiday “the best.” Be truthful to yourself and others about what you can and cannot do. And remember, nobody has a perfect holiday or perfect family.
3. Give to others. Volunteering somewhere, like a soup kitchen, food bank, children’s group home or facility for the elderly can fill you with feelings of love and pride. You will spend time with others and immerse yourself in the true spirit of the holiday season.
4. Stay connected. Schedule phone calls or virtual gatherings with your favorite folks where you can open gifts together, sing songs and reminisce. Spending time with those who love and value you can be very comforting and help ground everyone involved.
5. Acknowledge the past yet look toward the future. Change is a constant part of life. If your holidays are not like they used to be, it is OK. Cherish the memories and remember everything does not have to be like past holidays for you to enjoy the season.
6. Make a budget. Budgeting at the start of the season for holiday shopping and expenses is one of the most effective ways to alleviate stress. It helps prevent accidental overspending and allows you to manage expectations.

Want more tips for beating the holiday blues?

Visit the Magellan Healthcare holiday emotional wellbeing website for resources to help you find peace and moments of joy this holiday season here.

The United States (US) Food and Drug Administration (FDA) recently authorized the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11 years old. The Centers for Disease Control and Prevention (CDC) also recommended the vaccine in this age group. There are 28 million children in the US ages 5 to 11 years old. This age group makes up 39% of COVID-19 cases in those under the age of 18 years. While children are less likely to develop severe COVID-19 than adults, severe illness, hospitalization, and death have occurred in younger ages. Now that there is a COVID-19 vaccine option for ages 5 to 11 years, here are answers to vaccine questions that are top of mind for many parents.

1. How effective is Pfizer’s vaccine in children ages 5 to 11 years?

• According to results from the ongoing study in ages 5 to 11 years, the vaccine has been 90.7% effective in preventing COVID-19 measured 7 days after the second dose. The study has been going on with delta as the prevalent strain.
• Immune responses in this age group were comparable to 16 to 25-year-olds.

2. What are the common side effects?

• The most common side effect was injection site pain (sore arm). Some of the other common side effects include fatigue, headache, redness and swelling, fever, chills, and muscle pain.
• Side effects were generally more common after the second dose. Side effects were mostly mild to moderate, started within 2 days of the second dose, and resolved within 1 or 2 days.
• There have been no cases of myocarditis (heart inflammation) reported in this age group.
• The study is ongoing, and the FDA and CDC will continue to monitor for vaccine safety and look for rare or serious side effects.
• The vaccine should not be given to anyone who has a history of anaphylaxis (severe allergic reaction) to any part of Pfizer’s vaccine.

3. How is Pfizer’s vaccine dosed in ages 5 to 11 years? What type of vaccine is it?

• The dose for 5 to 11-year-olds is a two-dose regimen of 10 mcg given 21 days apart.
• It is a messenger RNA (mRNA) vaccine, but the dose is one-third of the adolescent and adult doses (30 mcg).

4. Can the flu and COVID-19 shots be given at the same visit?

• COVID-19 vaccine can be given at the same visit as routine childhood immunizations, including flu.

5. Where is Pfizer’s vaccine available?

• Pfizer’s vaccine for ages 5 to 11 years is available in pediatrician offices, pharmacies, health departments, hospitals, and other sites.  Vaccines.gov lists vaccine availability at different locations.

Disclaimer: The content in this blog article is NOT a substitute for professional medical advice. For questions regarding COVID-19 vaccines, any medical condition, or if you are in need of medical advice, please contact your healthcare provider. Given the fluid nature of the pandemic, information in this article is subject to change and may not be current.

Sources

• VRBPAC FDA Briefing Document. October 26, 2021. https://www.fda.gov/media/153447/download
• Pfizer EUA Press Release. October 29, 2021. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-receive-first-us-fda-emergency-use-0.
• FDA Press Release. October 29, 2021. https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age
• CDC Interim Clinical Considerations. November 3, 2021. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#children
• Pfizer EUA Fact Sheet. Revised October 29, 2021. https://www.fda.gov/media/153714/download
• AAP Policy Statement. November 2, 2021. https://www.aap.org/en/pages/covid-19-vaccines-in-children-and-adolescents-policy/
• Vaccines.gov.

Meredith Delk, general manager of the government markets division within Magellan Rx Management

What is the government markets division within Magellan Rx?

We are the largest pharmacy benefit administrator across 27 states and Washington D.C. working with Medicaid and public health agencies. We partner with states across the country to ensure that their Medicaid or AIDS Drug Assistance Program (ADAP) enrollees, depending on the state, have access to the drugs they need at the right time and at the right place. Additionally, we process approximately $18 Billion in rebate dollars on behalf of 20 states annually.

How does your work in the government markets division align with Magellan’s mission of leading humanity to healthy vibrant lives?

Our work is focused on people living in poverty across the United States. So, irrespective of the state and specific program, everyone we serve within the government markets division is affected by poverty and our commitment is to provide our customers (government agencies) and the consumers they serve with best-in-class service to access medications, therefore positively impacting their quality of life. We have about 1,000 employees on any given day who are dedicated across 27 states to ensure that the individuals we serve have a role in accessing their drugs and that they understand that their voices matter.

Further, we are deeply committed to our work across the country administering ADAP, thru our ADAP Center of Excellence. This is a federally funded program benefiting those who are affected by HIV and AIDS. As a result, these members are able to receive their life changing and lifesaving medications. In addition, there are wraparound services and other support services for people living with HIV and AIDS who do not have commercial healthcare and are not on Medicaid. The Ryan White program created a solution to ensure that, regardless of your socioeconomic status, if you are affected by HIV or AIDS, you will have access to medications. It is a fantastic program and one we are honored to be a part of here at Magellan.

Given everything that’s happening in healthcare right now with the pandemic, how does Magellan’s mission and improving customer service relate to the work you’re doing?

In many respects, the work we are doing in the government markets division supports the fabric of the safety net for millions of Americans. We know that through this pandemic unemployment has been on the rise, which means Medicaid enrollment has been on the rise, throughout the country. We also know that mental health issues have increased, creating additional challenges related to overall physical health and access to behavioral health services and medications. Within Magellan Rx and the government markets division, we’re on the front lines with our customers.

We partner with public health agencies to provide them real time solutions beyond our core POS work, for example. Right after the COVID vaccine was made available a Governor in a state where we have business announced during a press conference, that Magellan’s call center would be the vaccine hotline for every person in that state, regardless of their type of insurance. Almost overnight, we stood up a call center to support that state in improving their vaccination rates. We’re listening to and keeping a close eye on new and innovative challenges that Governors and Medicaid regulators have experienced during this pandemic.

How does your background in social work influence the work you’re doing and your leadership style?

I’m a trained clinical social worker and I also have a PhD in counseling. I have spent quite a bit of time while working on the PhD focused on people living in poverty who were also affected by a mental health issue and more specifically families who had a family member affected by severe mental illness. Additionally, I worked on the streets of Washington DC with people who were homeless and seriously affected by poverty, who also suffered from serious mental health issues. That’s really where I grew up in my 20’s, focused on people living in poverty and their access to mental health care. I worked at a lockdown stabilization unit for people who were suicidal and homicidal. It was a 7 p.m. to 7 a.m. shift on Friday and Saturday nights at the lockdown unit. That’s how I put myself through graduate school. I have seen firsthand the effects that mental illness and poverty combined have on people, families, and communities. In many respects, that is what created the foundation of my career. It helped establish the first pillar of my leadership style which is focus on your people first.

What is your strategy for keeping your team on mission and integrating them into the broader Magellan culture?

Every business leader and CEO rightfully would answer that question by talking about being best-in-class and supporting those we serve. I think the difference between us at Magellan and many other teams is the drive it takes to do that every single day. We are very disciplined about the data and metrics that bring to light how well we are doing on behalf of our associates, customers, and members.

I’m a former Amerigroup executive and Jim Carlson was the CEO when I went to work for them after spending a few years in state government. At AmeriGroup, I was very young and very green. I had the benefit of working under an extraordinary executive team led by Jim. Jim used to say, ‘don’t confuse effort with results.’  This aphorism has defined much of my career. To this end, we focus a great deal on the results we achieve with our customers, associates, and other key stakeholders.

The true measure of how well we are doing includes metrics like winning new business, bringing on new customers and retaining existing customers. In 2020, the government markets division earned a 100% customer satisfaction results. We surveyed all our government customers who are Medicaid regulators, and achieved 100% satisfaction, which is extraordinary and a direct result of the terrific work that our team does day in and day out.

Additionally, we have among the highest associate engagement scores on our internal customer service surveys. There are 28 people on my leadership team who bring 369 years of experience in our fee for service PBA (pharmacy benefit administration) business. On this team, 20 of those individuals have more than 10 years of experience with Magellan and eight of those individuals have more than 20 years. Three people have over 30 years of experience and the longest serving person on the team has 39 years of experience with Magellan. So, when you think about that, you know the turnover among leaders and subject matter experts is very low. This team is fundamentally about the people who come to work every day – they are truly focused on getting good work done, they like one another, they want to be here, they enjoy the work they’re doing and feel respected and valued for it.

What is exciting you about where we’re going, in terms of both Medi-Cal and Magellan Health as a broader company?

It is an exciting time for us in the government markets division. Medi-Cal is an extraordinary project, and it has been a true testament to the commitment and leadership brought by hundreds of people across the company and an exceptional California-based team led by Billy Thomas. They have shown up every day for the last year and a half, even during the pandemic, and are a team that’s so deeply committed to this work, and we will go live with Medi-Cal on January 1, 2022. The Medi-Cal project is transformative for the government markets division.

Additionally, we’re very excited about the work within the ADAP business. We’ve recently piloted our Navigate Whole Health program with our ADAP members. Results so far have shown us that very simple and straightforward clinical interventions with our providers and prescribers can really move the needle on quality and general efficacy of treatment modalities for HIV and AIDS medication. For example, we developed a regimen for one patient who didn’t want to take medications at work. As a result, the patient will be more compliant with the regimen. I believe it’s about adding more value and being a smart and sophisticated partner to these government entities and the people they serve.

Our national footprint allows us to be big thinkers. We can be more thoughtful and add more value because we are in 27 states across the country and every state is a little different. We also have the ability to leverage expertise, technology, infrastructure and innovation across the country.

Are you currently hiring for the Medi-Cal team?

Yes, we are. It’s a truly extraordinary project and an opportunity to be part of a team like no other in the country. There’s no state that has done quite what California has done with their Medi-Cal pharmacy benefit. This is a full drug carve out for all 14 million Medi-Cal enrollees.  It’s an opportunity to join a team led by Billy Thomas and his leadership team who are the best in the business. I also think it’s an opportunity to join a team where growth and development is a big part of the culture. We’re just very proud of the work that we have done with the state of California so far and are excited about serving them in a meaningful way. Anyone who’s interested in being part of that team should find out more. It’s a great team and it’s important work.

Learn more about joining the Medi-Cal team here.

The COVID-19 pandemic has had a profound affect on everyone, particularly children with emotional health concerns. Many support structures in place prior to the pandemic to help children thrive have disappeared or been changed significantly, resulting in increased pressure on caretakers and overwhelming stress for children. New and innovative solutions are needed to meet these challenges. Magellan Healthcare’s Emotional Health for Kids by Mightier is a clinically proven video game solution that helps children build emotion regulation skills through play and caregivers build emotionally healthy homes.

Developed at Boston Children’s Hospital and Harvard Medical School, Mightier helps children ages 6 to 14 who are struggling with emotional health concerns, such as irritability, aggression, and anger, as well as children diagnosed with oppositional defiant disorder, attention deficit-hyperactivity disorder, autism spectrum disorder (ASD) and general anxiety disorder.

Mightier’s impact on children’s emotional health

In a pilot program, Magellan provided members access to the Mightier program for a period of twelve weeks during the COVID-19 pandemic. Families were recruited and randomized into a group that received Mightier in addition to applied behavior analysis (ABA), or a group that received only ABA as a control.

• Children engaged with Mightier at a high rate. On average, Mightier families played for 30.4 minutes above the 30 minutes per week recommended to see clinical change.
• Clinical symptoms improved. Eighty percent of children with ASD who used Mightier showed an improvement on primary symptoms, compared to only 50% in the control group.
• Children showed twice as much decrease in aggressive behaviors. Adding Mightier to ABA resulted in a reduction in aggressive behavior in children with autism by twice as much compared to ABA alone.
• Families reported a less stressful and more supportive environment. Families using Mightier showed 50% improvement in family stress, 114% improvement in parent confidence, and 114% improvement in access to resources relative to control.

Visit  Magellanhealthcare.com/kids-emotions-mightier/ to learn more about the pilot and how Mightier helps children build self-regulation skills and supports caregivers in building emotionally healthy homes.

Among those who experience a mental health illness, more than half do not receive treatment.[1] The 2019 National Survey on Drug Use and Health reveals no treatment was received by:

• 90% of the 20.4 million individuals aged 12+ who have a substance use disorder (SUD)
• 55% of the 51.5 million individuals aged 18+ who have any mental illness (AMI)
• 35% of the 13.1 million individuals aged 18+ who have a serious mental illness
• 90% of the 9.5 million individuals aged 18+ who have a co-occurring SUD and AMI
• 57% of the 3.8 million individuals aged 12-17 who have had a major depressive episode

In fact, what we’ve seen in our data is that 60% of patients who are admitted to inpatient care were first seen in a primary care setting within 6-12 months of the admission and the mental health condition was either missed or not addressed.

Through effective screening for mental health conditions on your own or through a physician or mental health professional, it is possible to identify problem areas and get help, so you can live a happier and healthier life.

Mental health self-screening tools

Magellan Healthcare provides links to reputable, free self-assessments of behavioral/mental health, substance use and more.* Once you complete an assessment, be sure to review your results and any recommendations with your doctor.

• Addiction(CAGE-AID)
• Alcohol consumption (AUDIT-10)
• Anxiety (GAD-7)
• Bipolar disorder
• Child depression (CES-DC)
• Child trauma (CTS)
• Depression (PHQ-8)
• Drug abuse (DAST-10)
• Eating disorder (SWED)
• Insomnia (ISI-7)
• Obsessive compulsive disorder (OCD) (Y-BOCS)
• Pain (PEG-3)
• Parent mental health
• Postpartum depression
• Post traumatic stress disorder (PTSD) (PC-PTSD)
• Psychosis (PQ-B)
• Youth mental health

*Note these are links to outside websites that are not monitored by or affiliated with Magellan Healthcare. If your screening results indicate you are at high risk, call 911 or go to the emergency room immediately.

We encourage you to watch a recording of our webinar, “Depression is more than just a rough patch,” and find additional resources addressing depression at MagellanHealthcare.com/Mental-Health.

[1] https://www.samhsa.gov/data/sites/default/files/reports/rpt29392/Assistant-Secretary-nsduh2019_presentation/Assistant-Secretary-nsduh2019_presentation.pdf