In honor of World Hemophilia Day, Magellan Rx Management has released results from the first six months of its hemophilia management program launched in collaboration with Health New England, a non-profit health plan serving the commercial, Medicaid and Medicare markets.

Hemophilia is a rare genetic bleeding disorder, for which treatment is expensive and difficult to manage. The average annual cost per member with severe hemophilia can exceed $250,000, and may be upward of $1 million for members who have developed inhibitors. Personalized care programs for patients with hemophilia aim to reduce unnecessary costs while improving the overall quality of care.

“As April 17 is World Hemophilia Day, we’re excited to bring hemophilia care into the spotlight and highlight the early results achieved with Health New England through our hemophilia management program,” said Haita Makanji, vice president, clinical specialty solutions at Magellan Rx Management. “Through personalized interventions, we’re able to better determine the individual member needs and coordinate across key stakeholders to deliver a truly personalized care program that ensures members with hemophilia receive best-in-class care and achieve optimal outcomes.”

Since launching the hemophilia management program in August 2017, Magellan Rx Management and Health New England have standardized care across various stakeholders without compromising patient outcomes, resulting in:

• Optimized doses through assay management or pharmacokinetic (PK) testing in 50 percent of members
• Reduced average assay dispensed in prophylaxis patients from 5 percent to 1 percent, reducing the potential for waste
• No breakthrough bleeding reported from members who had a dose reduction

“In the past eight months of collaboration with Magellan, we’ve achieved our goals of ensuring high quality of care for members with hemophilia while minimizing potential waste created through excess dispensing and inappropriate dosing,” said Andrew J. Colby, R.Ph, MBA, Health New England’s pharmacy director. “By announcing our hemophilia management program results on World Hemophilia Day, we hope to raise the profile of this condition and look to continue to make strides in standardizing best treatment practices to benefit members across the country.”

The hemophilia management program aims to enhance overall quality and personalization of hemophilia care by coordinating with prescribers, members and pharmacies while reducing unnecessary costs. Key elements include:

• Helping payers analyze information related to member bleed history and hemophilia treatment patterns.
• Standardizing dispensing and optimal dose protocols to promote best practices and improve transparency in hemophilia care.
• Updating policies to encourage individualized treatment regimens based on member-specific metabolic factors.

Magellan Health today announced the launch of a new thought leadership website, www.MagellanHealthResources.com.

With a curated assortment of materials, focused around individual topics, Magellan Health Resources was designed as a repository of research, information and materials for healthcare professionals, members of the media and researchers.

To launch, Magellan Health Resources is showcasing information and materials around the opioid crisis.

The site includes videos  webinars, downloadable white papers, research, a news archive and more.

You can take a look here

By Carol Sickler, Screen Liaison Supervisor, TMG by Magellan Health

April is National Donate Life Month, and in honor of this, we would like to share a story from Carol Sickler, a TMG by Magellan Health Screen Liaison Supervisor. Fourteen years ago, Carol gave a life-saving gift to her brother, and she’s proud to be a living organ donor. Here is Carol’s story.

On March 18, 2004, I donated my kidney to my brother Lee. He had been in kidney failure for a year due to Berger’s disease (also known as IgA nephropathy) and was on dialysis. Berger’s disease causes the kidneys to become inflamed, which can affect how the kidneys filter waste from the blood. Since only 50 percent of people on dialysis live beyond 5 years, Lee’s best bet for long-term survival was to find a new kidney. I wanted to give Lee a fighting chance.

Our dad had also been on dialysis due to what we believed was Berger’s disease (it was never confirmed because he had other health issues, too). Unfortunately, our father was not a candidate for a transplant, and passed away in 2002 at the age of 72. My brother Steve also has Berger’s disease, but fortunately he has not experienced kidney failure (not everyone with Berger’s does).

Lee and Carol Sickler

Since this disease is hereditary, you might be wondering why I decided to donate one of my kidneys – wasn’t I at risk of Berger’s disease, too? Thankfully for me, Berger’s is primarily a disease found in males. It also tends to show up by the time a person is 40, and I was 40 at the time. So, for me, the risk of developing Berger’s disease was relatively low.

When I first considered donating my kidney, there were so many questions that were going through my mind about both of our futures, and if this was the right choice for us. However, my decision was solidified when the doctors at UW Hospital in Madison told us I was a match for Lee. And not just a match, but an identical match, with all six antigens matching as if we were identical twins, even though Lee is seven years younger than me. The doctors were baffled by this and had never experienced anything like this before. For me, though, I knew then that it was part of my life’s path to move forward and give my kidney to my brother. So, fourteen years ago we hugged and went into surgery together, becoming connected in a way we had never before imagined.

Today, we are both fully recovered and doing well. I personally have no regrets, and no health issues or ill effects from the donation. What I do have is an amazing bond with my baby brother Lee – the depth of this bond is unexplainable, and it’s something I would gladly give my kidney for again if I had to. Because organ donations are treatments and not cures, the kidney donation didn’t cure Lee of Berger’s disease, but it has allowed him to live a fulfilling, healthier life off of dialysis. Also, this gift of life allowed him to have a daughter, Jazmyn Carol, for which our entire family is grateful.

For anyone who is interested in becoming a living donor, there are a lot of great resources at both the www.organdonor.gov and at the University of Wisconsin Living Kidney Donor page. One of the most important things to know is that as long as the donor is evaluated thoroughly and cleared for donation, they will most likely lead a normal life after the surgery. And should a health condition arise because of the donation, there is a priority system in place on the National Transplant Waiting List so that living donors move to the top of that list.

I’m grateful that I had the chance to give my kidney to my brother, and love sharing my story in hopes it will inspire others to give the gift of life.

The following is an excerpt from an article appearing in the American Journal of Managed Care (AJMC)

More than 46 Americans die from prescription opioid overdoses every day, while the number of deaths from prescription opioids has more than quadrupled since 1999. Lack of expertise on how to measure and treat pain is a large factor driving the crisis. In addition, challenges in identifying those who are at risk for opioid abuse or who are already dependent on opioids adds further complexity.

Americans consume 80% of opioid painkillers produced worldwide. Yet the amount of pain reported hasn’t changed since in the past 2 decades, according to the CDC. For physicians, this points to the need to reconsider when to prescribe an opioid—if at all. Providers face intense pressures to adequately treat pain and may not know the data that supports nonopioid therapies.

Breaking the cycle of prescription opioid abuse requires new thinking around pain management and alternative options for helping patients deal with chronic pain. The following are 6 things physicians should consider before prescribing an opioid.

You can read the rest of this article in the American Journal of Managed Care (AJMC)

Traumatic events, such as a sudden death, natural disaster, motor vehicle accident, or terrorist attack can leave children and teens feeling stressed, frightened, and helpless. Whether they personally witness the event or are exposed to it on the news or social media, children may experience intense emotions and a heightened sense of insecurity. Children’s reactions to a traumatic event depend on their age and personality, the severity of the event, the availability of support, and previous experience of trauma

Tips for all ages

Traumatic events can disrupt children’s sense of safety and result in fears and worries, nightmares, and physical reactions such as headaches, stomachaches, problems sleeping, and loss of appetite. Here are suggestions to help children through the emotional and physical challenges they may face after trauma:

• Be aware of your own reactions to the event and manage your own stress. Stay calm and offer hugs and reassurance to help restore your child’s sense of safety and security.
• Share information about the event and answer your child’s questions honestly. Listen to your child’s fears and let him/her know it is okay to share his/her feelings at any time.
• Limit or prevent exposure to disturbing news and social media coverage of the event. Children who see graphic images or hear distressing news stories may become re-traumatized.
• Maintain stable routines as much as possible, including regular mealtimes, bedtimes, and exercise.
• Engage in fun activities to help children relax and feel that life is returning to normal.
• Watch for signs of trauma, even after weeks have passed. Children cope with trauma in different ways, and some may show signs of sadness, anxiety, and troubling behavior weeks or months after the event.

Tips by age group

Preschool age

After a traumatic event, children who are age five and under may display behavior from an earlier stage of their lives, such as bedwetting, thumb-sucking, clinginess to parents, and fearfulness of strangers. They may have tantrums or cry more than usual, or become withdrawn from others. Parents and other adults can help children by providing comfort and reassurance, maintaining routines as much as possible, encouraging them to express their feelings, and giving simple explanations to children’s questions about the event. Children look to their parents for cues as to how to feel and react, and will pick up on a parent’s distress or anxiety. It is best not to expose young children to the news on TV or the radio about the traumatic event. Involving toddlers and preschoolers in fun activities and playtime with others will provide a healthy distraction.

Early childhood

Children ages 6 to 11 may show some of the same reactions that younger children have, such as reverting to more childish behaviors. They may have nightmares or trouble sleeping, find it difficult to concentrate in school, become irritable, anxious or disruptive, or lose interest in family, friends, and fun activities. Parents should reassure children that they are safe and will be taken care of no matter what. Encourage family discussion about the event and answer questions, but be careful about exposing children to news and TV footage. Keep bedtime and meal routines as normal as possible, and involve children in activities that keep them busy. Identify the positives such as community recovery activities and the ways people help each other get through difficult times.

Adolescence

Older children ages 12 – 17 may have stress reactions such as nightmares and flashbacks of the event, lose interest in school, hobbies, and friends, feel angry, guilty, or depressed, withdraw from others, have physical symptoms such as headaches, or abuse alcohol or other drugs. As with younger children, parents can help teens rebuild a sense of trust and safety by listening to their concerns without judgment and providing them with peer support opportunities. Age-appropriate volunteer activities can help teens feel useful and productive.

When to get help

Be aware of signs that a child may need extra help coping with the trauma. If six weeks or more have passed since the traumatic event and your child is not feeling better, has trouble functioning at school or at home, is withdrawn from friends and family, or continues to have physical complaints such as headaches, stomach pains, and problems sleeping or eating, contact a mental health professional.

The Centers for Medicare and Medicaid Services (CMS) Star Rating program is designed to measure and improve the overall performance and quality of care health plans provide to

Medicare beneficiaries.  Due to changes in individual measure specifications, benchmarks, and inclusion into the overall calculation, this quality rating system continues to evolve – which can make it challenging to achieve and maintain 5-Star performance.

Listen to our latest webinar to learn about clinical strategies that can help you stay ahead of the curve for various Part C and D clinical measures such as rheumatoid arthritis management, osteoporosis management, statins in diabetes, and medication adherence for diabetes, hypertension (renin-angiotensin system antagonists), and cholesterol (statins).

March is Developmental Disabilities Awareness Month. Today, people with developmental disabilities are more visible across our communities than ever before, and the world is more accessible than it’s been in the past. It’s good to see things are becoming more inclusive, and it’s important for us to continue in this direction. Including people with disabilities into our communities enriches society as a whole – people of all abilities have gifts to offer, and when we find ways to let people share their gifts with others, we all benefit.

One way people can share their talents and become more included in their communities is through employment. Having paid employment gives people a sense of pride, and indicates that the work being done is valued by the employer. It also is a vital component of how people remain independent – when you’re making money, you have purchasing power over the clothes you buy, the food you eat and the home you choose to live in. You don’t have to rely on others to buy all of your necessities for you. It allows you to live a self-determined life where you call your own shots. Unfortunately for many people with disabilities, it can be a challenge to find paid employment. According to a survey of 17,682 adults with intellectual/developmental disabilities conducted by National Core Indicators, only 19 percent of those surveyed had a paid community job, but an additional 47 percent wanted one. These numbers are disheartening, and it’s up to us to start bridging the gap.

One of the roadblocks some people with disabilities run into is figuring out ways to earn money using their gifts and talents. Many will embrace their entrepreneurial spirit and create micro-enterprises: small scale business where they sell things they create, such as jewelry, art, crafts, greeting cards, homemade jams or provide services to those in their community. The possibilities are only limited to their imaginations! Others look to be a part of the traditional workforce, and thanks to programs like Project SEARCH – a national organization that partners with local business and teaches young adults with disabilities the skills they need to get the work they desire – more and more people with disabilities are finding jobs across all kinds of industries. According to the Wisconsin Project SEARCH Expansion, Project SEARCH, which is focused mainly on supporting young adults with intellectual and developmental disabilities, has a national employment success rate of 73 percent.

Melissa Rademacher

Melissa Rademacher, a young woman from central Wisconsin, is one of the many Project SEARCH success stories. Melissa is also enrolled in TMG by Magellan Health’s Wisconsin self-directed long term supports and services (LTSS) program called IRIS. After the restaurant Melissa was working for unexpectedly closed, Melissa turned to Project SEARCH in 2015, where she received her job training at the Kalahari Resort, a large waterpark, conference center and resort in Wisconsin Dells, which has been dubbed the “waterpark capital of the world.” There, she trained in housekeeping and in the bakery, as well as at the spa, which proved to be a fantastic fit. She was offered a job at the spa, and she’s been a spa attendant there ever since. Melissa’s work includes greeting guests and taking them to the relaxation room, stocking shelves, changing out the spa robes and putting guest information into the computer. Since starting at the spa, not only is Melissa in her dream job, but she’s a valued employee and has made wonderful friends at work.

Melissa’s story is a great example of what can happen when we set people up to succeed on the job. In fact, Wisconsin Governor Scott Walker was so impressed with Melissa’s story that he shared it during his State of the State address this past January.

Another key component to helping people with developmental disabilities find meaningful work is embracing the Employment First movement, which believes that everybody can work and that there is a job for everyone. Most states have some type of effort focused on the Employment First philosophy, and an increasing number of states have an official state policy, through legislation or executive order, indicating that employment in the community is the first and preferred option for people with disabilities. Wisconsin is part of this growing trend of state activity. Here, Employment First legislation, which Magellan Health supports, is expected to be signed into law soon. By getting laws like this in place, we’re building a culture that recognizes the value that people with disabilities bring to the workplace, in turn opening up more doors for employment for all.

These changes aren’t going to happen overnight, but if we continue making strides for inclusive work environments, it’s only a matter of time when they become the norm, and not the exception. And when that happens, everybody wins. Because everyone has something to offer, and anyone who wants to work should have the opportunity to do so.

To find out more about employing people with disabilities and what your state is doing to support Employment First, please go to these websites:

Department of Labor: Employment First Policy Resources

APSE: Employment First, Employment for All

This article first appeared on KevinMD.com. You can read it here.

After being prescribed opioids for just one day, individuals can face significant challenges with addiction, with six percent continuing to use opioids a year later, according to the Centers for Disease Control and Prevention (CDC). The likelihood of long-term use increases sharply after five days of use.

While much of the discussion around the opioid epidemic has centered on the challenges of opioid use and recovery, to get to the root of this national public health emergency, providers must focus on diminishing the risk of addiction before patients take their first dose.

How can providers best help patients reduce the probability of addiction when prescribing opioids? There are five key strategies providers should consider as a first line of protection against dependence and addiction.

Pair patients with chronic pain management coaches. Ideally, this step should be considered before an opioid is prescribed. Pain management coaches use digital therapy and motivational interviewing to help patients manage their pain without turning to opioids. When patients are prescribed a short-term dose of opioids, pain management coaches can be used to help transition patients off opioids by teaching techniques to manage pain without turning to opioids.

Partner with behavioral health experts who can identify patients who are most at risk of addiction. To avoid an opioid addiction before it starts, providers must understand the factors that increase patients’ risk of becoming addicted. These include behavioral health conditions such as depression and post-traumatic stress disorder—conditions that contribute to the experience of pain. Look for tools that can help identify patients’ behavioral health risk factors at the point of care, and establish partnerships with behavioral health professionals that help ensure patients also have access to pyschosocial treatment as needed. Some behavioral health solutions enable patients to participate in their treatment virtually, providing access to care for rural patients for whose availability to local behavioral health resources presents greater challenges.

Follow best practices on dosing limits. Ensure the morphine milligram equivalent dose and duration of treatment prescribed follow CDC and Centers for Medicare & Medicaid Services (CMS) best practices. Consider non-opiate alternatives before prescribing opioids, and carefully evaluate whether long- or short-acting opioids should be used based on CDC and evidence-based guidance.

It’s also important to collaborate with payers and pharmacists to gain visibility into patients’ past history of opioid use and evidence of previous substance abuse prior to writing a prescription. Patients who are at high risk of becoming addicted to opioids include those who have faced challenges with addiction in the past and who frequently visit the emergency department for pain relief. This information could help determine whether opioids are prescribed and, if so, the specific dose and duration of treatment.

Proactively engage patients in their treatment. Educate patients on the use of non-opioid medications that are just as effective as opioids.  When opioids are necessary, talk to patients who have been prescribed opioids for the first time on how they work, the risks of opioid use, and how to use opioids appropriately to reduce the risk of addiction. Consider this being much like informed consent before any medical procedure. Look for ways to engage patients not only in managing their use of opioids, but also in managing their physical and behavioral health, before, during and after using opioids.

Offer 24/7 access to healthcare professionals for patients who have been prescribed opioids. Doing so will provide a critical resource for patients who need help understanding their opioid prescription or feel as if they have a problem managing their response to their medication. Know your state’s Good Samaritan laws to ensure users of opioids that it is safe for them to seek care. Consider a hotline for opioid-using patients, staffed by nurses or an outside service to give patients and providers instant access to expert guidance.

Best practices for a complex challenge

As the opioid crisis continues to evolve, understanding the factors that place patients at highest risk of addiction before opioids are prescribed is key. Taking proactive measures to evaluate whether opioids are truly needed and how to best manage patients’ use of and response to these highly addictive drugs is critical to helping patients avoid serious health complications and live healthy, vibrant lives.