There are many healthcare-oriented apps in the marketplace, but there are few out there that offer cognitive behavioral therapy (CBT) and that have also been built on a multi-decade foundation of program efficacy data. Magellan’s CBT apps engage participants in psychoeducational content and activities through interactive sessions designed to maximize self-management of behavioral health symptoms such as sleep, depression, and anxiety. We recently released three apps to the Apple App Store including RESTORE (for insomnia and sleep problems), FearFighter (for anxiety, panic, and phobia), and MoodCalmer (for mild to moderate depression) and have plans to release two to three more in the near future.

But what does it take to build and release these kind of apps?

First and foremost, teamwork.

The best apps, healthcare or other, are not built by one person. They require a team of individuals coming together to work towards common goals. Our primary team includes two product owners, and two project managers who collectively work to get the vision from senior leadership (e.g. sketching ideas, wireframing, developing a curriculum), and then oversee the development teams building the apps (e.g. writing user stories, participating in daily scrum meetings, recording and producing videos, providing feedback), and then ensure smooth and timely deployment of various iterations that get delivered to our customers (e.g. delivering training, scheduling releases, communicating upgrades). Without teamwork these critical processes could not be completed and the App Store would have three fewer apps.

Second, and also very important, user feedback.

We have tens of thousands of active users on our platform, and we know that the majority of individuals who do two or more sessions report improvements in their sleep and mood. Therefore, it is very important for us know how to keep our users engaged. To drive engagement we seek out users and give them the opportunity to give us feedback on what would make our apps more helpful and more useful. Importantly, our users do not just include patients, members, and consumers, but also clinicians, care managers, and providers. We investigate how they use our apps and what features they would like to have included.  We incorporate this user feedback into our development sprints using what are called “user stories.” User stories help keep us focused on the core needs of our users, and they give us clear actionable tasks that can gauge what makes our apps successful and can also determine development steps for future iterations. For example, when we started asking our users what they would like added to our apps’ user experience, we learned about different features they would like to see. To help frame those features from the user perspective, we listed them out in user stories, such as, “As a RESTORE user I would like my sleep diary data to sync with my sleep data in the HealthKit app on my iPhone, so that I can see how data from my wearable device aligns with the sleep goals I set in RESTORE.”  When we roll out features developed from user stories, we see our engagement grow from previous years, and we validate our overall approach.

Lastly, we need to measure, test, learn, and keep building.

Our apps include a lot of content, in both English and Spanish speaking versions. The primary psychoeducational components include video recordings of narrators and clinical vignettes. The videos vary in length, and for each video embedded in the apps (there are dozens) we need to measure the length, test how long we can keep users watching, and learn from their experience. We have found that some videos are more watched than others, and we have found greater acceptance with shorter video length. Aside from just the videos, we have run a battery of tests on the features embedded in our apps and platform. These tests help us work out the bugs and improve the overall user experience. Once we are satisfied with our testing, we determine our readiness for release. Apple is pretty thorough with its acceptance and release of apps to the App Store, and we were very pleased with the turnaround time. We are now preparing to release our apps to Google Play, and will also be releasing later iterations with enhanced graphics, text-based reminders, and other features recommended by our users. Ironically, our apps are both complete and never finished, but I look forward to seeing how our apps will evolve, and continue to lead individuals to more healthy, vibrant lives.

Between January 30 and February 1, Magellan hosted its Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. Our annual gathering of healthcare insiders, experts and leaders provides opportunities for key members of the industry to talk openly about the future of healthcare. You can read part one of our review of the 2017 event here.

Building and Planning for the Future

Day two keynote speaker, Salim Ismail, chair of ExO Works, best-selling author of Exponential Organizations and former executive director of Singularity University, gave a fantastic overview of the exponential business model and how it applies to healthcare. Pointing to a wide variety of other industries, Ismail showed that disruption is powerful, creating both problems and opportunities. If a company fails to respond, it can quickly become overwhelmed — case in point, the photographic industry’s reaction to digital cameras. When the public embraced digital imaging, the market for film and film development disappeared; however, a whole new slew of problems arose allowing opportunity to flourish. In this case, the large number of images created by the average person needed new solutions, namely how to store and organize their digital pictures.

Ismail explained that there was a doubling pattern of exponential growth in a basket of many technologies. He also pointed out that humans are, in fact, not very good at accepting exponential growth. Our brains do not track exponential growth well, preferring scalable efficiency. Ismail gave advice on how companies (in healthcare and beyond) can prepare themselves to not just deal with exponential change but to lead it. Michael Guyette, president and CEO of Blue Cross and Blue Shield of Minnesota (BCBSMN), gave some key insights into how that spirit of disruption and innovation can look in the healthcare world. Guyette relayed how BCBSMN had created a unique program focused on innovation and diversification that has resulted in ways they can improve the health of communities they serve. “You need to have focus. Otherwise, you’re just going to go all over the place with innovation,” Guyette said. “But we as leaders need to make sure that we embrace our legacy while we start to reach out for the change of the future.”

Big Data Leading to More Personalized Care

One particularly interesting discussion centered on the rise of big data. While the concept of data-driven healthcare may seem impersonal at first glance, several voices argued that it can actually lead to more personalized care. For example, Michael Neidorff, chairman, president & CEO, Centene Corporation, brought up software that track genetic and genomic patterns. This data can be used to map cancer at the individual level, allowing for personalized care. Similarly, the ability to collect and process personal health data was brought up by Seth Dobrin, vice president and chief data officer at IBM Analytics, as a powerful and personal disruption of the health care industry.

Brian Flanigan, principal at Deloitte Consulting, brought up the fact that healthcare is in an affordability crisis. 76 percent of consumers rate the healthcare system as poor or average and costs are rising to unaffordable levels. Flanigan pointed to the use of innovation and data to provide the high-level, personalized services that consumers demand at more affordable prices. Using data and new technology, Flanigan pointed out, will literally allow us to do more for less.

Discussion with Peers and Experts

When we first developed the Magellan Open Vision Exchange, we wanted to avoid the typical corporate conference format and create a genuine exchange of ideas and experiences between healthcare peers and insiders. Once again, we were thrilled with the level of dialogue, questions and answers that we heard from our speakers and panelists.

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.

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.