Trouble sleeping? You are not alone. Sleep problems and insomnia affect nearly 40 percent of Americans each year. Not only is insomnia very common, it is also associated with increased risk of stroke,^[1] diabetes,^[2] obesity,^[3] alcohol misuse,^[4] depression^[5] and anxiety.^[6]  When individuals have insomnia and another one of these conditions, it can be particularly problematic. Cognitive behavioral therapy (CBT) is widely recognized as the gold standard for long-term management of insomnia.^{[7],[8],[9],[10]} However, CBT can be difficult to access and is relatively inaccessible for individuals with limited economic security.

Through increasing access to quality, well-studied CBT programs, Magellan seeks to reduce the overall cost-of-care and improve individual health outcomes. Team members at Magellan recently collaborated with academic researchers on a project to make Magellan’s computerized CBT programs, referred to as Cobalt, accessible to patients with insomnia in a community health setting. Participants included individuals who lived in shelters and community homes, as well as individuals with serious mental illness.

Participants received access to RESTORE^TM, one of several data-driven programs in the Cobalt suite, which has been shown to be effective in randomized controlled trials. RESTORE^TM has also won praise from the American Academy of Sleep Medicine ^[11] and received the highest rating from the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices. The research findings, published in the Journal of Clinical Sleep Medicine, demonstrated significant improvements in sleep quality. This suggests that implementing RESTORE^TM in a community mental health center setting may make accessing effective tools for improving sleep a straightforward process.[12]

Magellan continues to lead in the healthcare field through collaborations like this one, where academic partners are collecting real-world data that demonstrate how its industry leading Cobalt programs can help increase access, lower costs, and improve individual health outcomes. We are excited by the power of technology to improve care and access to care for individuals regardless of their economic status, as we work to lead humanity to healthy, vibrant lives.

[1] Elwood, P., Hack, M., Pickering, J., Hughes, J., & Gallacher, J. (2006). Sleep disturbance, stroke, and heart disease events: evidence from Caerphilly cohort. Journal of Epidemiology Community Health 0:69-73.

[2] Cappuccio, F., D’Elia L., Strazzullo P., & Miller, M.A. (2010). Quantity and quality of sleep and incidence of type 2 diabetes. Diabetes Care; 33:414-20.

[3] Gangwisch, J., Malaspina, D., Boden-Albala, B., & Heymsfield, S.B. (2005). Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep; 28:1289-96.

[4] Crum, R.M., Storr, C.L., Chan, Y-F., Ford, D.E. (2004). Sleep disturbance and risk for alcohol-related problems. American Journal of Psychiatry;61:1197-203.

[5] Riemann, D., Voderholzer, U. (2003). Primary insomnia: a risk factor to develop depression? Journal of Affect Disorder; 76:255-9.

[6] Breslau, N., Roth, T., Rosenthal, L., Andreski, P. (1996). Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.  Biological Psychiatry;39:411-8.

[7] Schatzberg, A. F., & Nemeroff, C. B. (2009). The American Psychiatric Publishing textbook of psychopharmacology. Washington, D.C: American Psychiatric Pub.

[8] American Psychological Association. (2004). Getting a Good Night’s Sleep with the Help of Psychology.

[9] American Academy of Sleep Medicine (2013). Evaluation and Management of Chronic Insomnia in Adults.

[10] Agency for Healthcare Research and Quality. (2013). Clinical practice guidelines for the management of patients with insomnia in primary care.

[11] American Academy of Sleep Medicine. (2009). Online Cognitive Behavioral Therapy is Effective in Treating Chronic Insomnia.

[12] Feuerstein, S.D., Hodges, S. Keenaghan, B.C., Bessette, A., Forselius, E., & Morgan, P.T. (2016). Computerized Cognitive Behavioral Therapy for Insomnia in a Community Health Setting. Journal of Clinical Sleep Medicine.

Magellan Rx Management is hosting its annual Specialty Summit from August 28-30, 2017 in New York City. This premier event provides insights, innovations and solutions for some of the pharmaceutical industry’s hottest topics.

DO YOU HAVE A STORY TO TELL?

If you have compelling research or new ways to drive innovative thinking that can help solve complex specialty pharmacy challenges, we want to hear from you! Magellan Rx Management is accepting proposals now through March 13.

Click here to submit your story, and learn more about the Specialty Summit here. 

Heart disease is the leading cause of death for both men and women, but you can make healthy changes to lower your risk of developing heart disease. Controlling and preventing risk factors is also important for people who already have heart disease. According to the U.S. Office of Disease Prevention and Health Promotion, ways to lower your risk include:

• Watching your weight.
• Quitting smoking and stay away from secondhand smoke.
• Controlling your cholesterol and blood pressure.
• If you drink alcohol, drink only in moderation.
• Getting active and eat healthy.

February is great time to take control of your health and know your health numbers.

According to the Kim Foundation, one out of four Americans experiences behavioral health issues. Of those, 60 percent are not receiving treatment.

Why are so many people not receiving treatment?

What does this mean for providers?

What more can be done to increase access to behavioral healthcare?

Learn more about this issue by downloading Magellan’s new infographic, “Mind the Gap: Increasing Access to Behavioral Healthcare.”

Millions of people are challenged by drug and/or alcohol use, which may result in physical and emotional health concerns. Many individuals feel like they have lost control and struggle with depressive signs and symptoms, in addition to substance use – and only a fraction of these individuals receive care, according to a report on addiction released in November by the U.S. Surgeon General.

At Magellan Health, our clinical methodology for the management of substance use incorporates leading principles of care, involving appropriate assessment, evidence-based interventions, as well as close collaboration with other healthcare providers who are vital to the delivery of effective care. At the core of Magellan’s interventions for substance use is our suite of computerized cognitive behavioral therapy (CCBT) programs powered by Cobalt Therapeutics, as well as screening software, and optional wraparound telephonic support.

Magellan’s Cobalt platform includes online, well-studied programs proven to help individuals who are coping with various behavioral health conditions. Among our Cobalt CCBT programs is SHADE – a 10 session mobile and web-based program for individuals living with alcohol, and/or drug use and co-morbid depression. SHADE provides skills-building exercises, which include mood monitoring, problem brainstorming, pros and cons analysis, planning for change, identifying problematic thought patterns and developing effective drug refusal skills. SHADE helps participants control their substance use, alcohol use and low mood by promoting long-lasting skill-based changes in behavior and thinking.

Published in the journal Addiction, SHADE has been proven in randomized, controlled trials to:

• Be comparable in efficacy to face-to-face therapy.
• Reduce hazardous drug and alcohol use by 44-58 percent after 6 months.
• Reduce hazardous use by 72 percent after 12 months.
• Significantly reduced binge drinking.

SHADE was listed favorably among the technology assisted interventions highlighted by the surgeon general’s report as a tool designed to “(1) increase access to care in underserved areas and settings; (2) free up time so that service providers can care for more clients; (3) provide alternative care options for individuals hesitant to seek in-person treatment; (4) increase the chances that interventions will be delivered as they were designed and intended to be delivered; and (5) decrease costs” (see https://addiction.surgeongeneral.gov/ for more information).

You can learn more about Magellan’s Cobalt CCBT capabilities here:

Magellan’s self-guided Computerized Cognitive Behavioral Therapy from Magellan Health on Vimeo.

Ransomware, malware, distributed denial of service attacks, Mirai – bad actors in a scary sci-fi thriller targeting your personal computer (PC), tablet or gaming device? Cyber attacks look for vulnerabilities in any system, not just your PC. Many sectors including credit cards, banking, government, retail and social media are objects of cyber attacks. The healthcare ecosphere, particularly medical devices, are a prime target of cyber bugs. In fact, healthcare is the number one industry when it comes to breach of data and generally lacks specialized security controls. Moreover, personal health information is 50 times more valuable on the black market than a credit card.

Ransomware, which block access to a computer or network until money is paid, are on the rise with 88 percent of attacks occurring in healthcare. Earlier this year, a California hospital paid $17,000 to cyber intruders to regain control of its electronic health network. Just last year, Anthem’s database of about 80 million people was also hacked.

Internet-connected medical devices, hospital networks, and other devices fall in the realm of Internet of Things (loT). Like computers, these connected devices can be hacked, potentially affecting the safety and effectiveness of the device and compromising patient privacy and safety.

In October 2016, J&J reported the potential for hackers to exploit a security susceptibility in the Animas® One Touch Ping® insulin pump. This could force the pump to deliver unauthorized insulin injections, leading to a possible insulin overdose, which can be life threatening. In August 2016, there were denied allegations about a possible dangerous cyber bug with one manufacturer’s cardiac devices. Last year, the FDA issued a few warnings about potential cyber bugs with Hospira’s (now Pfizer) infusion pumps. Despite these reports, the FDA is not aware of any cases where hackers have exploited cyber vulnerabilities to harm a patient.

In January 2016, the FDA made medical device cybersecurity a priority by issuing draft guidance for manufacturers. It provides direction to monitor, identify, and address cybersecurity vulnerabilities throughout the medical device lifecycle. This is largely a voluntary framework to aid manufacturers in building a scaffolded approach to minimize and mitigate risk.

Cyber attacks on medical devices are expected to grow and become more sophisticated as hackers continue to hone their craft. Threatened connected devices range from security cameras to coffee makers and from the federal government to medical devices such as MRIs, infusion and insulin pumps, and the list goes on. There is a proliferation of wearables and medical devices with software and programmable logic. When factoring in the evolution of electronic medical records and telehealth, regulators, medical device manufacturers, and health networks need to get savvier in order to provide solid security against this new reality.

“Every citizen has gifts. A strong community knows it needs everyone to give their gifts.”

– John McKnight, Asset Based Community Development (ABCD) Institute

In supporting people with disabilities in our communities, it is important to shift from using a lens shaded by needs and wear one focused on seeing people’s strengths, talents and assets. This new lens reflects the potential of each person and helps to move the conversation from one marked by:

• listing the services a person may need, to one identifying the contributions an individual can make,
• seeing a consumer as a user of services, to one recognizing a citizen who can access shared resources and have valued roles in their community, and
• viewing programs with limited resources, to one recognizing relationships and connections to one’s community with endless possibilities.

The 2016 conference for TASH, an international advocacy organization, provides a unique opportunity for people with disabilities, their family members, other advocates, and people who work in the disability field to come together and learn about strategies that meet the objective of this year’s conference to “reignite their passion for an inclusive world.” I led an interactive session that engaged participants in using tools to clear the path to inclusion, employment and community connections. Attendees learned how to use strength-based strategies to expand and translate their interests, gifts and talents into real connections and a better quality of life.

These strategies, when applied to community inclusion for people with disabilities, are based on an exploration of an individual’s gifts of hand, heart, head and human connection. Gifts of the hand are the things we know how to do. These are our skills, habits or rituals that we learn or naturally possess. Gifts of the heart include our passion or things we care enough about to give of our time and effort. Gifts of the head are the things we know or want to learn about, such as an interest in a local sports team or in a hobby. Gifts of human connections are the people we know and who know us – often called our social capital.

For decades, we have kept those who are different from us, including people with disabilities, separated from the community or segregated in spaces society thinks they feel more comfortable and can live in more safely. While approaches to school inclusion and community living strategies have tried to address this, these efforts have often been more focused on meeting the needs of professionals or systems, as opposed to the needs of people. Far too many people living in their communities are segregated from typical experiences and do not have access to opportunities they deserve as citizens. However, when we support people to create connections to others in their communities based on their natural gifts and assets, opportunities for real inclusion develop.

Consumerization of products continues to drive new innovations across the marketplace. For example, you can use your smartphone as a GPS device, to request a car service directly to your house and to shop for a new car online, seeing the prices other people paid in real time. In banking, we’ve seen the transition from teller to the ATM to online banking, smartphone banking and now, using your smartphone as a smart pay device. Underscoring all of these innovations is the desire to make whatever experience the consumer is engaging in easier, simpler and more personalized.

Healthcare is no different. Across the healthcare continuum, companies like ours are finding new and innovative ways to enhance member engagement and participation in the healthcare journey, particularly through computerized or mobile devices. Think about how healthcare has changed over the past 50 years – house calls from doctors to office visits to telephone triage and now, computerized therapy and text therapy.

At Magellan, we’ve invested in a unique type of computerized therapy – Computerized Cognitive Behavioral Therapy (CCBT) – to help individuals seek the therapy they need, in the comfort, convenience and privacy of their own home. Our CCBT programs were originally developed more than 20 years ago, for stand-alone personal computer use, but have since been developed for use on the internet and mobile devices, in both English and Spanish.

 The following five conditions make up more than 90 percent of behavioral health complaints in adults, and are present in more than 25 percent of adults:

• Insomnia
• Depression
• Anxiety
• Substance Abuse
• Obsessive Compulsive Disorder

Within each condition, studies have shown CCBT to be effective at reducing symptoms and severity. Importantly, our CCBT programs have undergone clinical trials involving more than 1,000 patients and have received endorsements and recognition from the American Academy of Sleep Medicine, the United Kingdom’s National Institute of Clinical Excellence, Accreditation Canada and the Substance Abuse and Mental Health Administration’s National Registry. Underscoring all of the studies and reviews, what can members expect? Sixty-nine percent of users show meaningful improvement within 30 days.

But CCBT isn’t just for members. We’ve found that providers can use a tool called Smart Screening to help screen individuals and triage them to the most appropriate levels of care on the CCBT platform, and in person, for the most serious cases. Various levels of screening can help direct individuals to CCBT, directly to an in-person counselor or a mix of both. Through this triage system, 90 percent of engaged participants rate this program as helpful and useful, and 75 percent of individuals actually prefer a non-medication care option when asked.

The most important thing about innovation in any industry – healthcare, banking or electronics – is refusing to rest on your laurels. There are new start-ups launched everyday whose mission it is to disrupt the status quo and provide new ways of doing things. As healthcare evolves, we plan to do the same.