In 2019, Time magazine listed virtual reality (VR) as one of the 12 innovations that will change health care and medicine in the 2020s. With this projection, the probability that you will use VR sometime in your life is high! VR is currently being used in a variety of fields, including

• Mental health
• Pain management
• Rehabilitation
• Training and education

VR is not a fad, as studies are underway for its potential efficacy to treat Alzheimer’s disease, depression, addiction, and other illnesses. This new field of medicine collectively referred to as medical extended reality (MXR), encompasses VR and augmented reality (AR). There are many aspects in the VR landscape including safety, regulations, and value to name a few. Let’s dive in and explore some of the clinical uses of this emerging trend.

Pediatric Intervention
Children are often under-treated and under-recognized when it comes to managing pain, fear, and anxiety. Thus, VR is utilized in children’s hospitals, such as Stanford Children’s Health, to engage and distract children during painful procedures. At the Lucile Packard Children’s Hospital Stanford, VR is used in several ways to reduce pain and stress, including the use of AR goggles for patients in the pre-op so they can watch movies and play games prior to surgery, and the use of VR games in the intensive care unit (ICU).

Mental Health Treatment
With an estimated 52.9 million adults suffering from mental illness in 2020 according to the Substance Abuse and Mental Health Services Administration (SAMHSA), one of the biggest challenges today is the rising demand for mental health treatment and a shortage of available providers. As another tool to tackle mental health conditions, VR now contributes to the availability of additional resources.

The use of VR software simulates real-world settings that closely resemble the surroundings of daily life so that triggering stimuli such as anxiety, paranoia, fear, and cravings can be assessed and treated. Anxiety disorders are already being treated using virtual reality exposure therapy (VRET) as a potentially scalable tool. In addition to anxiety-like disorders, VR is being studied for several other disorders.

There is evidence that VRET reduces post-traumatic stress disorder (PTSD) symptoms, with sustained improvements at six and twelve months after treatment. Among children with autism spectrum disorder (ASD), a recent research initiative demonstrated that VR combined with cognitive behavioral therapy (CBT) improved specific phobias. For seniors who suffer from social isolation, Rendever has developed a VR platform designed to reduce depression and loneliness.

Chronic Pain Treatment
A Centers for Disease Control and Prevention (CDC) survey in 2019 found that 20.4% of US adults have experienced chronic pain. Persistent pain is linked to depression and anxiety and can become an overlapping symptom.

In a study conducted by Cedars Sinai, VR reduced hospitalized patients’ pain scores by 24% and was most effective for patients with severe pain. In November 2021, a prescription medical device (RelieVRx) was authorized by the US Food and Drug Administration (FDA) as the first at-home VR therapeutic as an adjunct to treat chronic lower back pain.

Virtual Rehabilitation
While the benefits of physical therapy have long been established, some patients who would benefit from PT do not have access to it. In recent years, VR rehabilitation has been gaining traction with a host of conditions from chronic pain, stroke, and Parkinson’s disease to multiple sclerosis, dementia, and cerebral palsy. VR-assisted rehab may offer advantages for patients such as improved patient engagement and motivation, poststroke functional recovery, and improved mobility in Parkinson’s patients.

Training and Education
It can be challenging for educators to meet learning objectives through standardized medical training, especially as healthcare systems evolve. VR training and education, allow personnel, students, and residents to learn in a controlled environment while minimizing risks to real patients. As a result, VR systems are increasingly used in hospitals to train residents, assist surgeons with surgical planning, and educate patients. In a UCLA study, participants using the Osso VR platform significantly improved their overall surgical performance compared to conventional training methods.

Health Inequities
The healthcare system continues to be affected by structural racism, affecting the well-being of all people, especially those who have historically been marginalized. The use of VR as a training tool is currently being explored for a better understanding of the cultural needs of patients, with the possibility of VR becoming a tool for increasing empathy and giving people a broader perspective when interacting with individuals of different racial and economic backgrounds.

With VR technology developing at record speed and its potential to transform healthcare, we are keeping VR on our radar. We encourage you to learn more about VR and the world of MXR by visiting our website to explore our latest white paper: Virtual Reality – An Emerging Paradigm in Healthcare

This is just the beginning!

Primary care providers can be responsible for everything from first line dermatology to behavioral health to musculoskeletal injuries. In a world of rapidly changing technologies, and in which new therapies can cure or alter diseases that only a few years ago would have never been thought possible, the basics still matter. As a clinician, I’ve practiced internal medicine and psychiatry, and still have the opportunity to work with a FQHC in building integrated care. Those experiences and my national view of utilization and prescribing patterns highlight the need for provider support to care for persons with mental health conditions, including opioid use and abuse.

It is often challenging to translate new medical knowledge to the clinic setting. How does a provider care for the individual on a potentially lethal combination of opioids, benzodiazepines, and muscle relaxants? Or, how does one address the young child who has been placed on a combination of psychotropic medications.

In our current health system, primary care providers are in the best place to begin patient care journey or change the course of an already established treatment plan. An effective solution for supporting providers in delivering high quality care is in the form of provider support, especially through programs that involve data analytics, followed by one on one academic detailing. PBMs are in a unique position, having the ability to assist providers in working with patients on complex behavioral health or opioid regimens. PBMs have access to data that allows for identifying outlier member and provider behavior and finding patients who are at risk for adverse outcomes. While PBMs don’t have access to prescription drug monitoring programs, they can see what prescriptions are filled, where there is overlap, and where there are multiple providers interacting with a patient.

Magellan Rx developed the Live Vibrantly: Whole Health program to address those outlier providers and members, with the goal of achieving higher quality care. This program uses evidence-based algorithms to find members who may be at risk for adverse outcomes, and targets prescribers who may be over-prescribing. We become the provider’s go-to source for translating the evidence to the bedside through assistance with difficult issues, such as withdrawing an individual from high dose opioids. Through taking an approach to support providers in delivering high quality care, we’ve been able to truly partner in leading our members to leading more healthy vibrant lives.

For healthcare providers, prior authorization (PA) via fax or telephone is the second most costly medical administrative function. On average, medical staff spend two business days per week on PA. Automating PA while maintaining clinical excellence is essential for better care delivery. With a focus on leveraging digital solutions and fostering data-enabled decisions, Magellan Healthcare is building more provider-friendly approaches to improve care.

Recently Magellan announced a collaboration with Stanson Health, Premier, Inc.’s clinical decision support (CDS) technology division, to deploy DecisionPoint, an industry-leading automated PA solution. Powered by Premier’s CDS technology, DecisionPoint is available at the point of care and supports true automation within the electronic health record (EHR) and the physician workflow, making the PA process easier and more efficient for providers, patients and health plans.

DecisionPoint is built with Magellan Healthcare’s Advanced Imaging Management program clinical guidelines and Premier’s award-winning technology platform. Magellan maintains one of the industry’s most comprehensive evidence-based sets of clinical guidelines. Our clinicians develop our criteria through an extensive process of innovation and refinement. We base these guidelines on the analysis of public, peer-reviewed articles; health plan medical policies; the Centers for Medicare & Medicaid Services (CMS) policies; specialty physician reviews, professional society guideline statements; and other rigorous reviews of scientific documents. We continually monitor peer-reviewed literature, professional society guideline statements, and CMS-covered criteria to update our guidelines regularly, no less than annually. Initially, DecisionPoint will include our suite of the 20 highest-volume advanced imaging studies that make up 85% of all requests.

Working directly in the EHR, DecisionPoint guides provider decisions in real time in response to key workflow events, such as ordering an advanced imaging study. Integrating within the EHR improves efficiency while ensuring safety and quality and reducing undesirable variation in care.

Rules-based programming leverages EHR data, locating all relevant patient clinical information and citing appropriate Magellan clinical guidelines. Requests that satisfy the clinical guidelines are automatically approved and posted in the EHR, and approval IDs are automatically loaded to the record. With a confirmed authorization determination, the member leaves the appointment with a clear plan of action.

Hawai‘i Pacific Health (HPH), one of the largest healthcare providers in Hawai‘i, is leading the way in automating prior authorization by piloting DecisionPoint to help ensure their patients receive real-time, evidence-based decisions at the point of care whenever possible. Administered through HPH’s Accountable Care Organization (ACO) with over 800 physician members, the pilot leverages Magellan’s clinical guidelines and our full panel of clinical experts. We expect DecisionPoint to be available to additional providers in the fourth quarter of 2019 and include additional specialties and tests in the future.

The healthcare industry is in the midst of a significant paradigm shift as it transitions from a fee-for service model to value-based care. As a technology-augmented service backed by the support of providers, DecisionPoint is designed to minimize the industry’s challenges by fully integrating with EHRs at the point of care to enable faster PA and help deliver on the triple aim—improved quality, reduced cost and improved patient/provider experience.

To learn more about DecisionPoint, click here to go to our website, or email ProviderSolutions@MagellanHealth.com.

When Magellan Health received word that it had been named a Fortune 500 company for the first time in our company’s history, it was cause not only for great celebration, but also reflection.

In recent years, we’ve experienced tremendous growth and momentum. Our purpose—“Leading humanity to healthy, vibrant lives”—fuels the work of our more than 10,000 associates, who are dedicated each day to making a meaningful difference in members’ health and their lives. One of our biggest growth drivers has been our ability to innovate and introduce new products that resonate and disrupt the industry across all areas of healthcare and pharmaceutical management, with the ultimate goal of delivering a consumer-centric model that improves health and health outcomes.

At Magellan, our model of care is unique in that it is both high-touch and high-tech, supported by an innovative and inclusive culture. Three keys to our success stand out.

When it comes to innovation, Magellan’s secret sauce is its culture. We continually seek people from outside the healthcare industry to challenge the status quo and help drive innovation around access to care and care quality with their unique perspectives. By providing our associates the space, flexibility and resources to experiment, we encourage creativity and offer the freedom to pursue ideas that push traditional boundaries. We put a great deal of trust in our talented colleagues instead of relying on a structure that in and of itself is defeatist for innovation.

We innovate with the member in mind. At Magellan, we’re dedicated to consumer-centric care that achieves improved outcomes by integrating healthcare across physical, behavioral and pharmaceutical services. By pioneering new strategies, we’ve been able to tackle the highest-trend components of healthcare expenditures using agile, clinically based technology and applying advanced analytics to develop next-generation solutions. This approach not only enables highly personalized services to be delivered, but also supports the best possible outcomes in the most cost-effective way for our members.

For example, roughly half of total pharmacy spend is driven by specialty drugs, with half of that specialty spend covered under medical benefits. This portion of specialty spend is typically unmanaged by pharmacy benefit managers and health plans. Magellan has differentiated itself in the specialty drug management space by pioneering innovative strategies focused on improved outcomes and value. We provide high-touch decision support tools that support specialty physicians in ordering complicated drug regimens. These tools help to ensure treatments are being administered at the most clinically appropriate site of service and are appropriately used.

We pursue atypical collaborations. Transforming healthcare requires unique collaborations to fuel new solutions that achieve disruptive change and improve health. A majority of our unique collaborations are in the digital therapeutics space. Two years ago, we partnered with Click Therapeutics to create FDA-approved therapeutic apps for treating common behavioral health conditions such as insomnia, anxiety and depression. One example is an app called ComfortAble^TM, which helps people suffering from chronic pain identify and change unhelpful thinking and behavior and learn new problem-solving techniques. At a time when our nation faces an opioid epidemic, much of which stems from difficulties in managing pain, ComfortAble^TM presents an opportunity to curb the use of pharmaceuticals in pain management.

An Eye Toward Tomorrow’s Healthcare Model

As Magellan has migrated to a culture of innovation, one of our biggest learnings is the need to innovate with a small “i.” We’ve learned over time that the best ideas aren’t always going to be big, bold-stroke, billion-dollar ideas. Ultimately, we’re innovating to help people live better, healthier and more vibrant lives. That’s a purpose all of our associates, from our senior leaders to our interns, not only embrace, but act upon.

At Magellan, all of our initiatives are centered on one objective: to provide highly personalized services that support the best possible outcomes in the most cost-effective way for our members. We will continue to innovate and introduce products that resonate, disrupt the industry and make a meaningful difference in people’s lives.