We live in a fast paced, on-demand world, one in which information is available to patients through multiple channels on any medical topic. So, how do you help your patients navigate all the information and working with them, determine what is right for them and their loved ones? How do you help patients understand a diagnosis or a medical condition that needs to be effectively managed?

Care management is a solution that is intended to improve patient care and reduce the need for medical services by helping patients effectively navigate their own health condition. These programs have become a vital tool for organizations in order to meet the needs of their patients while also effectively improving quality and reducing the cost of care. Care Management can be provided by various types of clinical professionals, such as nurses, social workers, and pharmacists.

A successful care management program should include an integrated suite of services such as:

1. Care Coordination: Coordinating with the patient’s physician on assessments, care planning, and interventions.
2. Patient Engagement: Identifying opportunities for patients and developing a care plan that is supported through educational tools and resources to help them achieve their healthcare goals.
3. Health and Wellness: Helping patients make positive and lasting changes to their health through establishing healthy habits and setting achievable goals.
4. Advanced Digital Tools: Providing patients with the convenience and ease of managing their health through digital applications.
5. Data Analytics: Identifying members at risk for non-adherence or in need of care management through data-led and evidence-based algorithms.

A care management solution should be a comprehensive system that offers a suite of products to help patients navigate their health journey. Our MRx Navigate program is one such program that offers a medical management solution for customers and patients. MRx Navigate integrates data-driven, population health, and personalized intervention that leads patients to healthy, more vibrant lives. To learn more about MRx Navigate, click here.

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.

With the number of opioid-related overdose deaths in the U.S. reaching a record high last year, it’s time for our nation to fully embrace evidence-based treatment options that best support our communities, loved ones, friends and families in their recovery efforts.

One growing approach—often considered as the gold standard of treatment—is medication-assisted treatment (MAT). MAT is the use of FDA-approved medications in combination with counseling and behavioral therapies to provide a holistic, person-centered approach to the treatment of substance use disorders (SUDs). The use of this treatment approach has grown to nearly 40 percent in residential facilities and is increasingly leveraged by primary care providers nationwide—but more still must be done for widespread adoption.

The most pervasive stigma surrounding MAT is that it merely enables patients to replace one addiction with another. It’s a belief held not only by some groups of doctors and clinicians, but also family members and peer support groups—those whose support is critical to successful recovery. When a patient’s core support system of family members and peers doubts the legitimacy of an evidence-based form of treatment, the likelihood that the patient will follow through long-term is diminished.

Pair that with a lack of understanding and comfort from the medical community around how to administer MAT, limited numbers of physicians who are certified to prescribe this treatment that actually do prescribe the treatment, as well as the number of residential facilities that offer MAT, and we get low adoption rates as a result of these barriers.

There’s a better way to treat opioid use disorder

Although abstinence-based therapy works for a small percentage of those suffering from OUD, MAT offers a successful way for people to fight their addictions in an outpatient environment, in the community in which they live, and avoid hospitalization or institutionalization. It helps those struggling with OUD and other SUDs address underlying conditions that may have contributed to substance abuse—significantly improving the chances of recovery. In one study, more than half of patients utilizing MAT reported opioid abstinence 18 months after beginning treatment.

Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction. And even fewer actually prescribe buprenorphine to patients. MAT prescribing is not limited to psychiatrists. In fact, primary care providers provide more access to MAT than any other type of provider.

The impact of limited access to MAT on health outcomes cannot be overlooked. One analysis found only one-third of individuals who experienced a nonfatal opioid overdose received access to MAT. Those who received methadone were linked to a 59 percent decrease in mortality rates after one year, according to the analysis. Additionally, individuals who were treated with buprenorphine were associated with a 38 percent decrease in mortality after a year.

Increasing Access to MAT

The SUPPORT for Patients and Communities Act, signed in October 2018, expands the ability to prescribe MAT by increasing clinician eligibility for certification. This provision is a solid and necessary step toward broadening access to treatment; however to make a true impact on the opioid epidemic, we must break the stigma surrounding MAT.

When it comes to recovery, the potential for relapse is high, especially in the early stages when resolve is fragile. It is important to note that for individuals with co-occurring mental health conditions, chronic pain or other addictions, MAT should be supplemented by treatment for those conditions, such as cognitive behavioral therapy. Building in care management support to assist in navigating the treatment process may reduce the possibility of relapse and/or readmission to a substance abuse inpatient or residential rehabilitation program. It also helps provide individuals with the tools needed to live addiction-free.

By taking the time to dispel the myths about non-traditional addiction treatment like MAT, we create an environment that more fully supports a return to complete health—physical, mental and emotional. Fighting the stigmas around MAT is an important step toward enabling those suffering from OUD to recover from their addiction and live 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.

Our own Seth Feuerstein spoke recently at the APA annual meeting about how Digital Mental Health Care is increasing access and delivering positive outcomes.

“Here’s what’s interesting…subjectively, patients described [the digital program] as by far the most positive experience they have when they go to that center,” said Feuerstein. “Their engagement with it was kind of off the charts.”

You can read about Seth’s comments and more at the American Journal of Manage Care by clicking here

Note: This article originally appeared on LinkedIn, you can read it there by clicking here.

You cannot escape the responsibility of tomorrow by evading it today – Abraham Lincoln

On one of my many cross-country flights, I started to think about how the concept of employment has changed dramatically over the course of my thirty-year career in the US. In this time, information technology and globalization have changed how business is done, increased competition and improved workforce productivity in every industry. These forces have dramatically changed the employer-employee compact*, doing away with stable jobs, lifetime employment, pensions, and predictable career advancement. These have been replaced by a dynamic, ever changing, ever evolving workplace. It’s not a stretch to say the Future of Work is very different, it is emerging and changing right in front of our eyes, and it requires:

• New skills: Students going through school will very likely be in a job that hasn’t been invented yet and more than a third of the job skills that will be needed in 2020 are not considered crucial to the jobs of today
• Curiosity and Continuous learning: These same students are learning core curriculum content that will be out of date by the time they graduate. They need to develop the capabilities to make learning a life-long activity that they enjoy
• Resiliency and Adaptability: Provide the skills required to adapt to careers that have 10-12 job changes in their career and possibly change their career 3 or 4 times, and
• New models of employment: Many individuals with specialized skills will see their career as a series of “Tours of duty”, with a newly defined Employer-Employee compact*. Other employees will expect the flexibility to have more than one gig at the same time enabled by the Gig Economy.

The Workforce of the future is made up of tech savvy digital natives who are always on and always connected. They flow between work activities, personal tasks and gigs that fulfill their need for artistic, financial, security or other needs. These employees are highly adaptable continuous learners, who have a breadth of skills across multiple domains. Organizations need to have a different view of their workforce and talent. They need to plan for employees who:

• Seek a higher purpose and “meaning” to the work they do and balancing that with what they are good at and at the same time enjoying what they do (The Japanese call the “ikigai”)
• Want to pursue multiple jobs/roles/gigs that align with their values and needs
• Prefer to work from anywhere, at anytime through different modalities – work from home, co-working spaces, all-inclusive campuses or traditional workplaces
• Look for the work to come to them as opposed to moving their families to where the work is and spending several unproductive hours commuting in big cities. The nature of work today is increasingly digital, distributed and not constrained by geographical boundaries, it goes to where the skills are
• See work and life as two sides of the same coin. These employees go beyond traditional notions of work-life balance and embrace work-life flow where they work where they want and can handle their personal life when they need to.

At Magellan Health, we believe that communication, collaboration and community are core basic human needs. We believe that collaboration is a highly personal and uniquely human experience that is critical for us to achieve our Massive Transformative Purpose (MTP) of “Leading humanity to healthy, vibrant lives”. Our challenge was to see how we could build a collaboration platform that took advantage of the strengths of this workforce and addressed some of the opportunities and constraints that come with the workforce of the future.

In late 2016, we introduced Magellan Hub, our platform to enable the workforce of the future and make them thrive in the Fourth Industrial Revolution (4IR). Magellan Hub was designed with five foundational principles:

1. It had to be humanized, personal and democratic – the platform needed to be personal in a way that it gave every individual within the organization a unique voice that was their own. It also needed to be representative, self-governing and participatory (collaboration is not a spectator sport). It also should NOT allow for anonymous participation.
2. It had to support emerging modalities of communication – the platform had to go beyond Web 2.0 technologies to include emerging modes of communication including Groups/Communities, Videos, Group Chats, Video and Audio Conferencing, desktop NLP, and Chatbots
3. It had to bridge distance and time – In other words, it had to retain the context of conversations, the history of events and be searchable. In addition, it had to have the flexibility to support real-time and delayed interactions at the same time
4. It had to be everywhere and nowhere – this allowed people to be always connected when they needed to be and completely disconnected when they wanted to be. This enables both pull and push communications where users could opt-in to the content they wanted to see.
5. It had to be future proof – The platform had to be scalable to support our growth and be accessible from anywhere, at any time over no, low and high-bandwidth connections.

We believe in Magellan Hub, we built a platform that supports the workforce of the future to effectively handle the future of work. Here are a four examples:

• When Dana, a new employee joins Magellan, she is instantly connected to the broader community across Magellan. She has the choice to share what she wants to share, develop her unique voice and influence the dialog of her colleagues, her team or the entire company. She can subscribe to the content she wants to see, groups she wants to join, formal and informal leaders she wants to follow. In other words, Dana immediately becomes part of the Magellan Community the minute she gets an ID to access Magellan Hub
• Steve, a long-term Magellan employee, spends most of his time in infrastructure operations and is focused on his day-to-day tactical tasks. With Magellan Hub, Steve can be part of groups that are focused on the projects he is working on to stay in sync with the rest of his team irrespective of where they reside or work from. He can also join special interest groups around technical domains or social domains (such as Magellan Musicians) to connect with others with similar interests. He does all this on his Android smartphone as he is running personal errands working out of his home office.
• Lara, a highly engaged mid-level executive uses Magellan Hub to do a digital management by walking around to check on the pulse of her team that is spread across 12 states and 3 different time zones. She uses HD Videoconferencing and personal chat/video/audio conferencing through to enable these highly personal and humanized experiences without extensive travel. What’s cool is that Lara can have these humanized, high-touch interactions with her team from her home-office, from the indoor gym as she watches her kids play or from an airport as she waits for her flight to take off
• Jeff, who is a product manager developing our next leading edge Cognitive Behavioral Therapy tool can collaborate real-time with his colleagues and team members from different departments across the company to create, edit, comment on shared product specifications in a secure way. At the same time, he uses a closed and private group to discuss and collaborate on these product specifications and coordinate the development of this product across the company.

At Magellan, we are the employer of the future who is fully committed to continuously exceeding the expectations of the workforce of the future. While we may not be there yet, with Magellan Hub, we provide a collaboration platform for employees so that they can do their best work every single day and they become the change that we want to see.

References and Notes:

* Hoffman, R., Casnocha, B., & Yeh, C. (2013, June). Tours of Duty: The New Employer-Employee Compact. Harvard Business Review.

** World Economic Forum. (January 2016). The future of jobs: Employment, skills and workforce strategy for the fourth industrial revolution. http://www.weforum.org/reports/the-future-of-jobs

*** The name Magellan Hub was selected by our employees through a crowd-sourcing contest that was conducted on the platform

Magellan’s own CTO, Srini Koushik, was recently featured in Forbes Insights, talking about the benefits of videoconferencing and how it is changing the way that we work at Magellan. In the article, Srini discusses how new technology is improving efficiency while increasing connectedness and effectiveness of teams.

Check Srini’s profile here.

Earlier this year, Srini shared his experiences reimagining Magellan as a digital healthcare company here on the Magellan Health Insights blog. Take a look at his views here.

The past decade has seen some remarkable changes in technology, which has ushered in an era where we are always “on,” always connected and where most everything that was analog now is digital. Many of us walk around with powerful computers in our pockets –also known as smartphones–that are more powerful than the computers that help put a man on the moon only a few decades ago. Today, we can order car rides from our phones, pay for our groceries, watch movies or do just about anything from a smartphone or network-connected device from anywhere across the globe. Yet for many of us, we go through a time warp when we move from our personal lives to our work environments.

Magellan: a Digital Healthcare Company

At Magellan, we have an inspired leadership team that is building a workforce of the future. We recruit the best talent wherever we can find it across the globe and provide them with great work-life integration by providing flexible working arrangements. Over 40 percent of our workforce does not work in one of our offices, and many of our employees are mobile and on the road helping our member and providers. This kind of a workforce requires the collaboration platform of the future.

During the summer of 2016, we assembled and rolled out Magellan’s next generation collaboration platform. This platform was built with a mobile-first, cloud-first, always digital mindset designed to provide secure, seamless and context-aware experiences within the enterprise. This new platform is all about providing choices: it works across Macs and PCs, across browsers, across Apple and Android mobile devices and can work across a 4G connection and high-speed wifi alike.

The platform uses five technologies that we use in our personal lives on a daily basis:

• Workplace and Workchat for desktop and mobile devices. These are the enterprise- grade versions of Facebook and Facebook Messenger, complete with networking, group collaboration and social sharing capabilities.
• A cloud-based document and content management solution from Box.
• Enterprise-quality HD video conferencing and desktop sharing through Zoom.
• Productivity applications from Microsoft through Office 365.
• An integrated access portal tied together by a robust security and identity management solution from Okta.

Okta acts as a gateway to every other application, website or solution provided by Magellan. It simplifies password management and provides secure multi-factor authentication – in short it makes our applications accessible to everyone, anywhere, at any time over any network or device. It allows an employee to take a video call from her home office and collaborate with her colleagues in a Workplace group and continue that conversation on a mobile device as she takes the train into see a customer for an afternoon meeting – secure, seamless and context-aware collaboration.

 Technology leading culture; culture leading technology

One of the interesting developments in our culture is the use of desktop and mobile video conferencing which allows us to personalize each call, read body language and emotions and share the true benefits of face-to-face communications, instead of being on nameless, faceless, monotonous conference calls.  This is changing the cultural fabric of Magellan by making the enterprise more personal and more social.  It is challenging our management orthodoxies and help reinvent management.

With this new platform, we are building communities that span geographies, business units, departments and even companies. In the past year, we have seen over 700 groups evolve organically on this platform.  Some of these groups focus on specific projects, initiatives or events, and others focus on communities of users and social groups. We even have a community of musicians at Magellan. In short, the platform helps people stay connected in a personal way without having to be located in the same spot.

Ultimately, our technology is a means by which we can help improve the experience – and quality of care – for our customers and members. Our objective for this new platform is to make the technology invisible to the user and allow them to seamlessly play their part to help individuals live healthy, vibrant lives.