By Caroline Bohn, R.N., Senior Care Manager, Magellan Behavioral Health of Pennsylvania

Millions of Americans suffer with chronic pain issues, every day of their lives. Conditions such as migraines, back injuries, fibromyalgia, or neuropathy, for example, can cause serious, ongoing pain. Ongoing chronic pain can be a debilitating problem for those suffering with it. Dealing with a chronic pain issue can lead to additional problems, such as a loss of pleasure in life, inability to work, poor sleep or depression. People often seek treatment for chronic pain, to be able to live a better life.

We live in a fast-paced world where we can access just about anything, 24 hours a day, 7 days a week. We can shop and order things on the internet at any time of the day or night, or even go to stores that are open 24/7. No longer must we wait for someone to get home and check an answering machine to receive our messages because we can reach out to others in an instant via cell phones, email, texting, and instant messaging. Going to the movie theatre or buying a DVD in the store are almost obsolete. The limitless availability of television and internet streaming services allow us to watch our favorite shows and movies at any time. The ability to get so many needs met instantly, leads us to expect this type of immediate fix for everything in our lives, including medical issues.

It is understandable that people desire immediate relief from pain, and there are many ways in which pain can be treated successfully and alleviated. One option, which people often choose, is the use of prescription pain medication. But the natural desire to relieve pain immediately can cause people to opt for taking pain medication before trying less invasive alternatives. There are many options for treating chronic pain without prescription medication. For example, interventions such as physical or occupational therapy, transcutaneous electrical nerve stimulation (TENS), acupuncture, biofeedback, or cold laser therapy. Wearing supportive braces or orthotics can be helpful with eliminating pressure on inflamed areas. Yoga, weight loss, and therapeutic massage can aide in reducing muscle and joint pain. Mind-body techniques are also effective methods to address pain, such as meditation, mindfulness, progressive muscle relaxation, and deep breathing exercises. To clarify, the use of prescription pain medication is not an inappropriate choice, but it is wise to explore other options as well. Pain itself, is not a disease. Pain is a symptom or signal used to alert us that something is going wrong within the body. Use of medications to eliminate the pain signal, is not helping fix the problem that is causing the pain. The first step to solving a pain issue is to identify and address what is causing the pain so you do not have to experience pain in the first place. There are situations where it is not possible to eliminate the source of the pain completely, but in cases like these, there could be treatments available to lessen the severity of the pain, so it is manageable with less medication or without the use of medication at all.

Regular use of prescription medication to alleviate pain could cause other issues to arise, even when a medication is appropriately prescribed by a physician and taken according to the physician’s orders. Unfortunately, it is possible for your body to become dependent on certain types of prescription pain medication. Dependence on pain medication is evident when an individual experiences symptoms of withdrawal when taking less of the medication or stopping it altogether. If a person feels they must continue taking pain medication to avoid experiencing withdrawal when not taking it, this could indicate that their body has become dependent on it. If this occurs, a consultation with your physician to discuss next steps is essential.

There are different classes, or types, of pain medications which can be prescribed by your physician. One of these types, called opioids, has a greater risk for dependence than other types of prescription pain medication. If your body becomes dependent on opioid pain medication, it can be difficult to stop taking it. Opioid pain medications have a higher risk for causing withdrawal symptoms when discontinued than other types of pain medication. People could experience nausea, vomiting, sweating, feeling excessively hot or cold, or muscle aches throughout their body, when taking less of or stopping the opioid pain medication. If this were to happen, alerting your physician is crucial. Your physician can assist you with safely discontinuing an opioid pain medication, so you do not have any withdrawal symptoms. If you do not feel comfortable telling your physician you may be dependent on opioid pain medication, there are other ways to seek help. If you have access to the internet, you can visit the SAMHSA website (https://www.samhsa.gov/find-treatment) to get education and information about seeking help with opioid pain medication dependence. If you do not have access to the internet, SAMHSA offer a toll-free helpline as well (SAMHSA’s National Helpline: 1-800-662-HELP (4357).

There is nothing wrong with seeking help when your health is at stake. Reaching out to a trusted family member or friend, to ask for their help, is also a great way to start on the road to your recovery. Above all, it is important to remember that maintaining your physical health and well-being, is crucial to living your best life.

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

What is collaborative care?

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

Principles of collaborative care

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

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

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

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

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

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

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

New data from the Centers for Disease Control and Prevention shows that suicide rates have risen to over 30% in the US since 1999.[1] Since COVID-19 began, suicidal ideation in the US has more than doubled, with younger adults, racial/ethnic minorities, essential workers and unpaid adult caregivers experiencing disproportionately worse effects.[2] As suicide has reached crisis-level proportions in our nation, it’s time to recognize suicide as a public health crisis and learn about the warning signs and the skills needed to save a life.

Know the warning signs of suicide

It is hard to tell whether a person is thinking of suicide. Most people who take their own life show one or more warning signs, either through what they say or do.

• Feelings: Expressing hopelessness, talking about suicide or having no reason to live, showing moods such as depression, anxiety, irritability
• Actions: Showing severe/overwhelming pain or distress, using drugs or alcohol, searching for ways to end their life
• Changes: Withdrawing from activities, isolating from friends and family, sleeping more or less
• Threats: Talking about, writing about or making plans to kill themselves
• Situations: Going through stressful situations including loss, change, personal humiliation or difficulties at home, school or with the law

Take action to prevent suicide

Suicide remains the second leading cause of death among Americans between the ages 10 and 34, according to the CDC.[3] It is a major health crisis—and preventable. When someone says they are thinking about suicide or says things that sound as if they are considering suicide, it is important to pay attention and take action. Suicide is often preventable.

• Ask and listen: “Are you thinking about killing yourself?” is not an easy question, however, a study by the National Institute of Mental Health shows considering suicide may reduce rather than increase suicidal thoughts. Be willing to listen and discuss their feelings.
• Keep them safe: Reducing a person’s access to highly lethal objects or places is an important part of suicide prevention. Asking if the at-risk person has a plan and removing access to lethal means can make a difference.
• Get them help: Connect with a trusted family member, friend or mental health professional. Call the National Suicide Prevention Lifeline’s (1-800- 273-TALK (8255)) and the Crisis Text Line’s number (741741). Save these numbers in your phone so they’re there when you need them.
• Stay connected: Staying in touch after a crisis or discharge from care can make a difference. Let them know they matter and you care. Leave a message, send a text or call them.

For more information and helpful resources, visit MagellanHealthcare.com/Prevent-Suicide.

If you are in crisis or considering suicide, or if someone you know is currently in danger, please dial 911 immediately.

[1] https://www.nimh.nih.gov/health/statistics/suicide

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

[3] https://www.nimh.nih.gov/health/statistics/suicide

Creating an accessible and personalized user-friendly digital experience is Lauren Rust’s goal as vice president of digital experience at Magellan Health. Based in Houston, Texas, Lauren aims to make it easier for members to understand their behavioral health and find appropriate care, all while reducing the stigma surrounding mental health. By focusing on the needs of our consumers, Lauren and her team hope to create digital experiences that improve the overall wellbeing of Magellan Healthcare members.

Continue reading to find out more about what Lauren and her team are doing to redefine the digital experience at Magellan Health.

What projects are you currently working on at Magellan Health?

As Magellan Health continues transforming the space of behavioral health, a big aspect of that is reimagining our digital experiences. We’re redefining those experiences and the ecosystem that supports them for our members, employers, and providers. It’s about understanding the needs of our consumers and how we meet those needs. We start by listening to our members and taking the time to understand the member journey. Our undertaking is significant: providing integrated digital experiences that help members understand and address their wellbeing and mental health, access the appropriate care they need, and advance innovative approaches to improving behavioral health more broadly.

Why is Magellan Health the leader in this type of work?

Magellan Health is well primed to accomplish this work for many reasons. The first is that we have a long history of delivering the right quality of care to our members and meeting their mental health needs and helping them achieve wellbeing. We also have a culture that supports innovation and positions members needs at the forefront of our work. Additionally, our organization is mission-driven, and passionate about our members and the role that we play in transforming healthcare.

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

There is tremendous respect and recognition across the individuals and teams that make the work Magellan does every day possible. It’s a very collaborative environment, but also one with clear accountability which enables us to have empowered teams that are eager to take on transformative initiatives.

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

It drives excitement and urgency. It’s pushing innovation and a need to continue to evolve and support the needs of our consumers. All of which is essential to the work we are doing.

What are some goals you have in your position and what are some things you’d like to accomplish in your role at Magellan Health?

The most immediate goal we have is to meet the needs of our members by providing them digital experiences that enable them to find and access the care and resources that they need. To get there we are establishing a clear vision, a roadmap, and identifying the best-in-class experiences and offerings to improve wellbeing and mental health. Additionally, delivering on the needs of our customers and providers through quality digital experiences. We must address the behavioral, physical and pharmacy needs of people through an integrated approach that supports the member through their entire health journey. Equally as important, is the support we give to the providers who care for those members. We’ll accomplish this through high tech applications complemented with high touch clinical solutions based on a collaborative model of care and seamless healthcare ecosystem.

Any other comments you’d like to make?

For me, digital transformation often feels like a lot of experiences being launched to deliver on a larger strategy. I think it’s important that we’re focused on the member journey and that we’re trying to make things accessible, easy to access care, and understanding of your total wellbeing. We are excited to expand on Magellan’s clinical expertise and scale by bringing it to life in the digital experiences we deliver.

• Read more about the digital experience here.

As I started my career with a passion to add value to the healthcare industry, I would never have been able to predict the rapid evolution we are experiencing today. Take, for example, specialty pharmacy. What originated nearly 50 years ago as a treatment solution for just a handful of conditions has grown exponentially into a $250 billion industry now treating hundreds of ultra-rare conditions and orphan diseases. The explosive growth of the specialty pipeline, combined with the high cost and complexity of managing specialty patients (who often have at least one other chronic condition or comorbidity), highlights the need for payers to stay ahead of the trend and deploy targeted, future-focused management strategies for better specialty drug management.

Tracking the Trends

In 2008, there were eight specialty drugs approved by the FDA; compare that to 2020 with 53 total specialty drugs, and half of those approved for medical benefit use. Not only are the number and scope of specialty drugs increasing, but so are costs. So far in 2021, five high-cost therapies have been approved with price tags of $400K to nearly $750K—this is the new normal. As high-cost and potentially life-saving drugs continue to enter the market, it becomes more and more difficult to determine which patients should receive them and how they will be paid for.

In 2012, about one-quarter of total pharmacy spend was attributed to specialty drugs; in 2020, we have reached 50%. When you drill down even more, about half of that spend occurs on the medical benefit. Going deeper, oncology remains the top driver when it comes to overall medical benefit costs as the highest-spend category for the past 11 years—representing nearly 50% of total per-member-per-month spend for the Commercial line of business and over 60% for Medicare.¹ How can employers and payers keep track of these evolving market dynamics?

The Power of Magellan Rx Excellence

At Magellan Rx Management, we have nearly two decades of experience creating flexible solutions that allow our customers to improve patient care, stay ahead of trends, and reduce specialty spend across both the traditional pharmacy and medical benefits. As the original experts in medical pharmacy management, we have a deep understanding of the trends and demonstrate our commitment to advance thought leadership in this space with the annual Magellan Rx Management Medical Pharmacy Trend Report^TM. This Report is a one-of-a-kind resource that highlights key areas of spend and trend across commercial, Medicare, and Medicaid lines of business as well as management strategies for new and emerging therapies.

We also leverage our Expert Clinical Network of more than 175 key opinion leaders (KOLs) across multiple disease states that participate in peer-to-peer discussions and guide recommendations for patients with complex and hard-to-treat conditions. This is especially helpful for payers who lack in-house expertise in ultra-rare and orphan conditions as we work to secure specially matched, unbiased KOLs that are affiliated with major healthcare treatment centers nationwide.

And we don’t shy away from the hard stuff. Our legacy is solving complex pharmacy challenges and meeting the momentum of new developments head-on. In fact, that is what makes us stand apart from other PBMs—our integrated approach and account service model is designed to encourage innovation across clinical, formulary design, distribution channels, and medical pharmacy strategies. These unique solutions are prioritized and intrinsic to the value we bring as a partner.

• Medical Pharmacy Solutions with coordinated management across all sites of service, including utilization management support.
• Formulary Strategies for both traditional and medical pharmacy drugs that connect best-in-class formulary management and value-driven rebate solutions with clinical policies and medical pharmacy programs to manage costs.
• Specialty Pharmacy Distribution that takes a patient-centric, clinical approach to drive adherence and improve outcomes, along with cost avoidance and cost management solutions to reduce total cost of care.
• Condition-specific Programs that deliver better health outcomes and improved CMS STAR ratings.

One example of our devotion to excellence is the work we have done in preparation for the market entrance of oncology biosimilars. We started building the foundation in the autoimmune category and continued to refine our methodology, working hands-on with payers and pharma to create a solution that is not passive but evolves with the dynamic market. As such, our customers were able educate their providers and members prior to the availability of oncology biosimilars. Our impact? We’ve delivered over $40 million in annualized savings for early adopter health plans.

Unlock the Possibilities

I am proud to lead a team of industry experts and thought leaders who inspire me every day to challenge the status quo and add value to this complex area of healthcare spend. I would never have guessed that fifteen years post pharmacy school would have led me to where I am now, but I couldn’t be more grateful. Our team is poised to answer the industry’s toughest questions with thoughtful, clinically-focused solutions—and I’m confident we’re already prepared for the next wave of change. It’s in the spirit of our people to push the industry forward, and I take pride that we have the right experts collaborating with our customers to develop proven programs that drive real results.

Are rising specialty costs a concern? Let’s connect on how we can help solve your unique population’s needs. We’re here for you.

1. Magellan Rx Management Medical Pharmacy Trend Report™, 11^th Edition, © 2021

According to the CDC, 1 in 54[1] children is diagnosed with autism spectrum disorder (ASD), with some states reporting 1 in 32[2] children receiving a diagnosis.¹ One of the most common treatments for ASD is Applied Behavior Analysis (ABA), a therapeutic intervention that helps individuals with autism:

• Improve communication, social, daily living and motor skills
• Maintain positive behaviors
• Transfer skills and behavior from one situation to another

Because ABA is a newer treatment than psychotherapy and other therapies, limited academic literature exists to support providers in effective decision-making for intensity and length of care. In addition, treatment plans are individualized and require extensive monitoring with heavy reliance on caregivers, nearly 50%[3] of whom need help managing emotional and physical stress. This makes it difficult for families to gauge treatment effectiveness and contributes to the rising costs of mandated ASD treatment. In fact, according to the CDC, in addition to medical costs, intensive behavioral interventions for children with autism cost $40,000 to $60,000 per child per year.[4]

A shift from fee-for-service models, in which ABA providers are compensated for each procedure, test, treatment, etc. performed, regardless of whether they lead to better outcomes for the patient, to value-based care models that link payments for the provision of services to the quality of services provided and reward providers for efficiency and effectiveness, can help address these challenges and deliver stronger clinical outcomes when the models:

• Emphasize efficacy—Value-based ABA care models should define benchmarks that determine when the maximum benefit of ABA services has been achieved, measure progress against the benchmarks and empower providers in the decision-making process to ensure that intended outcomes are achieved during ABA treatment and beyond.
• Improve member engagement—It is essential that providers and caregivers work together as a team. By participating in regular discussions with providers on progress trends barriers, and ongoing assessment, caregivers are empowered to understand the overall direction and impact of ABA services and how their active participation in their child’s treatment planning and delivery has a strong impact on outcomes.
• Drive-data-informed decision-making—From the onset of ABA services, behavior analysts should set targets or specific behaviors selected for change based on skills assessments. Progress toward these targets should be monitored, analyzed for trends, and continuously discussed with caregivers. This high-engagement, data-informed process drives decisions on the next steps for ABA services, including whether to continue or slowly reduce the number of therapy hours, and enables providers and caregivers to select and use clinical services that will meet children’s needs.

Visit here to learn about Magellan Healthcare’s value-based collaboration with Invo Healthcare to define standards of care for children with ASD undergoing ABA treatment and improve ABA outcome

[1]https://www.cdc.gov/ncbddd/autism/data.html

[2]https://worldpopulationreview.com/state-rankings/autism-rates-by-state

[3]https://www.workforce.com/news/working-parents-finding-support-for-their-special-needs-children

[4]https://www.autismspeaks.org/financial-resources-autism-help

Irvin Towson, VP of Talent Acquisition, oversees all the Enterprise, Magellan Healthcare and Magellan Federal recruiting. Based out of Virginia and with seven years spent at Magellan Health, Towson takes pride in his team’s track record of finding the best talent to join Magellan Health. Targeting more than 2,500 hires this year, he is focused on recruiting strategies and execution, as well as the upcoming Centene acquisition.  We caught up with him recently to get his thoughts on how Magellan Talent Acquisition makes a difference in the lives of our teams and our members. Read more to see how Towson uses Talent Acquisition to help make a positive impact.

Q: What sort of cool projects are you working on right now?

A: This year we’re committed to hiring 2,500 people, so that’s exciting and keeps everyone more than busy. I’m always glad when recruiting is in an active state; I think it’s good for everyone within the company. I like that we have an impact on the lives of people and real-world issues and I’m looking forward to expanding upon that, too.

Q: How do you sell Magellan Health to potential new hires during the recruitment process? Why is Magellan Health the best place to work?

A: We always talk about our ability to impact the lives of people that we support, including how the mental health aspects of our work have come into greater focus. Also, Magellan Health is truly a very collegial organization. Companies often talk about fostering collaborative, collegial environments, but it is embedded in our DNA. These selling points attract exceptional talent to the company, since so many people want to be part of a great company and doing work that matters. I’ll also mention our culture of support and encouragement of remote work. That allows us to identify and recruit the most qualified candidates, irrespective of where they are located geographically. It opens a lot of doors for the company and individuals who could be interested in joining us.

Q: What are your thoughts on how the culture is here at Magellan Health, and how does that culture impact the recruitment process?

A: The leaders of this organization connect with employees in respectful ways. It is not an overly autocratic culture, in which the needs and feedback of team members are disregarded. I see a tremendous amount of mutual respect on display daily throughout the company and this makes a huge difference in someone’s experience at work. Most people here at Magellan Health are very engaging and interested in input from others, no matter their level in the organization. The willingness of leaders to be open and connect with people is one of our distinctive features and it defines the work environment we offer.

Q: Anything else you’d like to add?

A: In my view, acquiring talent is one of the most important things any company does, and I never forget how important it is to do that better than our competition. I’m very passionate about what I do and what we do at Magellan Health. Great organizations attract and keep the best people. It is through the best people that we create superb outcomes for our employees and help leading humanity to healthy vibrant lives.

• Read more about working at Magellan Health here.
• Learn more about working for Magellan Health here.

Over the past year COVID-19, community protests and increased social awareness have highlighted the impact of racism on the mental health of Black, Indigenous People, and People of Color (BIPOC). On April 8, 2021 Rochelle Wolensky, director of the Centers for Disease Control and Prevention, said that racism, “directly affects the well-being of millions of Americans. As a result, it affects the health of our entire nation.”

Magellan Healthcare is committed to increasing awareness about BIPOC mental health, wellness, and the importance of recognizing and addressing concerns. Learn more about racism and mental health.

Racism is a mental health issue because racism causes trauma. Racial trauma is the ongoing result of racism, racist bias, and exposure to racist abuse in the media and everyday life. Racial trauma can affect many aspects of a person’s life, including their ability to have relationships, focus on school or work, and feel safe. People who experience racial discrimination and injustice can develop trauma that causes anxiety, chronic stress, depression, and other mental illnesses.

How racism affects mental health

For those who are affected by racism, it is important to remember that you are not alone. The push for social change is strong and there are many things you can do to protect your mental health during this time.

4 things you can do for your mental health

The following strategies can help you gain a sense of strength, build resilience and stay healthy.

Share your feelings—It is normal to be angry, to feel hopeless, to cover up your experience of racism, or to pretend that it has not affected you. Talking about your feelings is not a sign of weakness, but part of taking charge of your well-being and doing what you do to stay healthy. The simple act of talking to someone who makes you feel heard and understood can trigger hormones that calm the nervous system, reduce stress, and relieve the symptoms of depression and anxiety.

Embrace your ethnicity and culture—Racism is often used as a weapon to belittle you as a human being and lower your self-esteem. You can counteract this and help deflect the pain of racism by developing a strong sense of your ethnic identity and strengthening your attachment to the community. Closer ties with people who share your experiences can help reduce the sense of isolation that often stems from racism.

Channeling your anger—No matter how justified your anger is, venting it uncontrollably will affect your judgment, reduce your chances of being heard, and negatively affect your health. Use your anger and channel it in a constructive way to bring about meaningful change. Join a community or activist group, engage in creative activity, or create a journal.

Take care of yourself—Because your body and mind are so closely linked, it is important to take care of yourself in times of overwhelming stress. You can improve your mood and your health by moving your body every day, learning ways to reduce stress such as deep breathing, making nutritious food choices, focusing on getting enough sleep, and finding a safe place to rest and recharge.

There are no easy answers to dealing with the pain of racial trauma. To move forward we need to take care of ourselves and our communities. We invite you to visit MagellanHealthcare.com/BIPOC-MH to learn more about Magellan events and other resources that are available to the public for BIPOC Mental Health Awareness Month and to like and share our contributions on social media.

Sources: Mental Health America, HelpGuide.org, Medical News Today, Mentalhealth.org.uk

Read more about mental health topics.