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.

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.

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

More than 70 healthcare thought leaders, providers, and other innovators gathered in Florida in late January to explore the profound impact that new disruptors are having on healthcare delivery models, financing approaches and outcomes.  For the third year in a row, Magellan Health’s ‘Magellan Open Vision Exchange’ (MOVE) innovation forum brought together executives, providers and analysts to collectively discuss how industry innovators can solve some of healthcare’s biggest challenges.

Over the course of three days of dynamic interaction on Amelia Island, the group participated in presentations and discussions from a wide range of experts – including a Pulitzer Prize-winning practicing oncologist, CEOs of several large public and commercial healthcare programs, futurists, entrepreneurs, and innovation change gurus.

The speakers at MOVE 2018 brought very different perspectives, but the messages they delivered hit remarkably consistent notes.  Healthcare is being transformed through ever accelerating advances in technology, leveraging the power of big data, and producing personalized health solutions that are radically changing the way disease is predicted, identified, treated and contained.  As more than one expert noted, many of us do not even realize that ‘deep learning’ – as population-based meta-data analysis is known – has already made its way into our homes, and indeed into our pockets.  Sam Srivastava, CEO of Magellan Healthcare, reminded us all that the humble Smartphone has much more computing power than the early super-computers.  Pulitzer Prize-winner Siddhartha Mukherjee explained how researchers are using voice data passively recorded on Amazon’s Alexa™ to identify early-stage Alzheimer’s disease.  And, as eminent futurist Jim Carroll noted: “Connected health homes are the new normal.”

How do these profound changes impact the healthcare delivery system? Or as one audience member mused:  “In a world where computers make most of the clinical decisions, what becomes of the traditional provider?”  The answer was encouraging.  Several panelists felt that when machines take over routine diagnostics and health maintenance, the doctor-patient relationship will actually be enhanced, as primary care providers will have more time to actively listen to their patients, and more flexibility to address the non-clinical determinants of health that positively impact healthcare outcomes.

In the short term, providers are preparing for a transformed healthcare landscape by investing time and resources in creative partnerships with health plans and health informatics leaders in an effort to re-define and augment their value proposition.  Leaders from Magellan’s healthcare and pharmacy divisions joined with GuideWell of Florida in a panel discussion that explored the ‘volume to value’ shift in Value Based Purchasing (VBP).  Participants suggested that, while finding the optimal value-based model has been elusive, some promising pilot programs are emerging.  Aligning provider and payer incentives remained a challenge, the group agreed, and even the best-designed VBP program will fail if it does not drive member accountability.  Dr. René Lerer, president of GuideWell, captured this sentiment perfectly when he said that an effective health solutions company no longer delivers managed care – but instead ‘delivers a managed life to each and every member.’

In other words, the key to good personalized medicine will always be the person at the center of the healthcare journey.  Tommy Duncan, CEO of Trusted Health Plan, revisited this theme forcefully when describing how his inner city D.C. health plan was able to achieve a remarkable operations and financial turnaround in only one year.  The secret, Tommy explained, was that Trusted pivoted its existing care management model completely to focus on high-touch, face-to-face interactions at brick-and-mortar ‘Wellness Centers’ staffed by interdisciplinary teams.  Using predictive modeling data as a starting point to identify high-risk, high-cost members, the Wellness Center model generated behavior change at the individual member level that resulted in a 60 percent drop in emergency room visits in only one year.  Erhardt Preitauer, CEO of Horizon Health New Jersey, delivered a similar message, and ended his discussion of long term care best practices with the comment, “It all comes down to personal engagement.”

MOVE 2018 came full circle with closing comments delivered by Barry Smith, CEO of Magellan Health.  Many presenters talked at length about vast cloud-based, technology-enabled data repositories. Barry brought the discussion back down from the data cloud to an intensely human level, when he told the story of how a group of 80 compassionate strangers formed a human chain to save a family in distress on a Florida beach not too far from the room where MOVE attendees were sitting.  The group of strangers bonded spontaneously around a common goal, unanimously determined not to fail, and focused single-mindedly on ensuring not a single member of the stranded family drowned.  As a vivid metaphor for MOVE 2018, Barry’s story moved everyone who heard it.  It was also a perfect reflection of Magellan’s purpose:  “leading humanity to healthy, vibrant lives.”

The room at the inaugural Magellan Open Vision Exchange (MOVE) this past March was a sight to see. Filled with a buzz of energy and openness to think differently, Magellan executives, clients and partners gathered in shared pursuit of a better, more efficient healthcare experience of tomorrow. Collectively, the leaders in the room had impact over the healthcare experience for a significant portion of America. Yet, the focus of the conversation was clearly in how to pivot care to be more accessible and effective, one person at a time.

Help One, Help Many

The event kicked off with stories from Mick Ebeling, CEO of Not Impossible Labs, whose commitment to changing the lives of a few individuals has sparked a few of the most impactful innovations in healthcare. From his entrée into healthcare innovation with the eyewriter, helping a graffiti artist paralyzed by ALS to create art again using his eyes, to Project Daniel, a 3D prosthetic printing process that started with the goal of creating an arm for a Sudanese boy, he challenged the group to “recognize an absurdity” and then to “just commit to figuring it out.”

Neither an engineer nor a healthcare expert, his “open source” method for creating healthcare inventions turned heads. He demonstrated a commitment to designing a solution through the eyes of the individual suffering, which made all the difference in his ability to impact lives. He reminded us that he did not have all of the answers -far from it. But asserted that a key point to breaking the mold was to think of challenges as “not impossible.” He reminded us that it would be very difficult to name something that is possible today that wasn’t at one point thought of as impossible.

Healthcare as an Experience

Our client presentations continued to emphasize applications of human-centered innovation in healthcare, sharing approaches grounded in first understanding the behaviors that drive and influence healthcare experience. Key takeways included:

• Remembering that the most common reasons for a hospital stay are the more common ailments of mankind, from childbirth to respiratory and circulatory conditions, musculoskeletal conditions and mood disorders. While emphasis is often placed on advancement in rarer, more specialized conditions, a significant portion of patients can be impacted by anticipating the needs for more routine healthcare experiences.
• Listening to what’s working, and what’s not, disease state by disease state. From crowdsourcing feedback from patients to understand what helped them get better, to creating focused innovation platforms within organizations to spawn creative solutions unencumbered by traditional perceived barriers, we learned of many approaches to closing gaps in the system.
• Speaking to people successfully living with their conditions provides tremendous perspective for recovery and chronic condition management programs. When the formula isn’t as simple as issue identification + treatment = healthy, concepts like peer support become an opportunity to support living well with a physical, mental or emotional challenge by empowering the patient to learn to thrive through peer experience.
• Re-positioning healthcare leaders as “chief experimenters.” It was underscored that healthcare leaders today can’t simply focus on making decisions, they must design and enable experiments to truly push the healthcare experience forward.

Stay tuned for Part 2 of our event recap.

Looking for more information about MOVE, our gathering of healthcare innovators and thought leaders? View media and request an invitation to our January 2017 event. For questions, contact mediarelations@magellanhealth.com.