I have had the privilege of wearing many hats in a variety of industries throughout my career, including as an entrepreneur, executive, board member, educator, inventor and investor in technology, healthcare, biotechnology and life sciences.

I have seen the development of ideas and innovations that never had the opportunity to come to fruition. There are a number of contributing factors that impact these advancements. However, one of the most frequent causes is that inventors and researchers do not have the proper experiences, training and education to advance their ideas and work from the research setting to the patient or consumer.

In addition to my role as chief innovation officer and chief medical officer of medical and digital innovation at Magellan Healthcare, I also serve as a faculty member at the Yale School of Medicine. It is through my role at Yale that I have the opportunity to lead a unique training program for substance abuse researches from across the country in entrepreneurship starting next spring. The work of these scientists focuses on the prevention and treatment of substance abuse disorders leading to innovative options for improved care. Unfortunately, many of these innovations never reach the market because today’s scientists do not have the training in how to commercialize their ideas.

The training program, called Innovation to Impact: Translation Support and Education, is made possible through the funding of a $1.25 million grant by the NIH National Institute on Drug Abuse (NIDA). Students will participate in a free five-day boot camp on entrepreneurship and product development and will also have access to an extensive network of new venture mentors, seed funding for new ventures and training in how to promote a culture of entrepreneurship locally.  This will also help start what we hope will be an active community hosted virtually as well.

In addition to my work in developing apps and software programs designed to combat substance use disorders, I have also been teaching entrepreneurship for many years. This program is a logical next step to not only advance these innovations, but significantly help people with substance abuse disorders.

Open to researchers across the country who are focused on basic science, epidemiology, prevention, treatment and policy, the program will help advance innovations that impact the substance use field. This work is of the upmost importance as we face a national crisis on substance abuse. I also believe the future innovations of these researchers will soon impact our work at Magellan and the customers and members we serve.

Magellan makes it a priority to advance innovation, as evidenced by its support of my participation in this initiative with the NIH as well as dedicated resources through various innovation initiatives to help develop and commercialize new product ideas or services. It is rare that you find a private sector company like ours that is committed to allowing its executives to undertake educational activities when they fit within our massive transformative purpose of “leading humanity to healthy, vibrant lives.” I’m excited to continue to focus on collective entrepreneurial spirit with an amazing team at Yale to share our lessons with others and bring new ideas to light.

Caring is at the heart of Magellan’s culture. Whether it’s approving grant applications through the Magellan Cares Foundation, utilizing paid volunteer time off (VTO) hours or matching financial gifts, this is continually demonstrated by our associates across the country. Learn more about the Magellan Cares Foundation by visiting our webpage, which includes information about how organizations can apply for grants, or learn more from our associates first-hand in this video.

Every day in the news we hear about the devastating impact of the opioid crisis across the country. While we need to confront this complicated crisis, we also need to examine the larger issue of substance use disorders (SUD) that impact millions of Americans.

This past September, I had the honor to represent Magellan Health at the first meeting of the Substance Use Disorder Treatment Task Force, founded by Shatterproof. The mission of the task force is, “To fundamentally improve substance use disorder treatment in the United States, in terms of both quality and patient outcomes.” It also addresses the underlying cause of our country’s current substance use crisis, and lack of access to quality and evidence-based treatment. The task force has been created to expand access to quality treatment for the estimated 21 million Americans with SUD.

This task force is unique in that it convenes public and private healthcare companies, advocates and former government officials to take the lead in developing a tactical plan with measurable goals for payers to follow and implement. I am proud to be joined by so many colleagues and experts across the industry.

Our first focus is to implement the recommendations outlined in the November 2016 Surgeon General’s Report on Alcohol, Drugs, and Health. Secondly, we will utilize methods outlined in a 2006 report from the Institute of Medicine which recommends the need for a group of government regulators, accrediting organizations, consumer representatives, providers and purchasers to come together to develop a common, continually improving set of quality measures, specifically for mental health and substance use disorders.

The work of this task force aligns nicely with our efforts at Magellan, helping lead individuals to healthy, vibrant lives. Working with individuals with SUD, from both the behavioral health and the pharmacy benefits management perspective, we are in a unique position to help address these issues. I believe we can make significant contributions on this task force and for the benefit of our customers, members and providers with whom we work.

Post Traumatic Stress Disorder, commonly known as PTSD, comes in many forms and affects children and adults alike. Early descriptions of PTSD are found throughout literature. The hallmarks of war-related PTSD were described in Homer’s The Iliad. Shakespeare wrote of the symptoms in Henry IV and A Midsummer Night’s Dream. In recent times, books such as The Things They Carried (Tim O’Brien) describe the effects of war and the risk for PTSD-related suicide. Movies such as Ordinary People and Mystic River portray the effects that loss and abuse have on families and individuals. The daily ease of access to images on the internet and television puts the fodder for PTSD in front of all exposed to electronic media. We have only to listen to the news to learn of all the possible inputs that can cause PTSD—the tornado that sweeps through a Midwest town, atrocities happening to people in places such as Syria, beheadings, and stories of abused children. PTSD can affect one individual at a time, or a lone event can bring PTSD into the lives of many with a single swath.

Prevalence of PTSD in the U.S.

PTSD is common. The lifetime prevalence of PTSD among adult Americans is 6.8 percent (National Comorbidity Survey Replication). For adolescents, the six month prevalence was estimated to be at 3.7 percent for boys and 6.3 percent for girls (Kirkpatrick, 2003). The prevalence is much higher among Veterans. Men and women who had served in the Vietnam War have a lifetime prevalence of 30.9 percent and 26.9 percent, respectively. Studies of Gulf War Veterans reported a current prevalence of 12.1 percent, and 13.8 percent for Veterans of Operation Enduring Freedom/Operation Iraqi Freedom (Kang, et al 2003; RAND Corporation 2008). Unfortunately, PTSD is often underdiagnosed in the medical setting—with symptoms being attributed to a “normal” response to a trauma, misdiagnosed as depression, or altogether missed because of the physical presentation of the condition.

PTSD Symptoms and Impacts

PTSD symptoms are not limited to only the emotional, but also bring physical impairment in many forms. The condition affects those people supporting the individual with PTSD, often causing distress to family, friends, and colleagues. It is important not to approach PTSD with a single point of view — the victim of a natural disaster may have different experiences and risk factors than a combat veteran, for example. What is the same, however, is a set of symptoms based in some form of exposure to a traumatic event, resulting in significant distress and impairment in an individual’s ability to perform in her or his roles, whether within family, employment, or other social units.

No matter the cause, the response to a traumatic event is similar, whether described in the 8^th Century BC, or in 2016. In 2013, the American Psychological Association updated the criteria used to diagnose PTSD. According to current diagnostic criteria, the diagnosis of and symptoms attributable to PTSD must include at least one month of:

• Direct exposure to a stressor; witnessing the stressor in person; indirectly learning of a loved one exposed to a violent or accidental circumstance; and/or repeated or extreme indirect exposure to aversive details of the event, typically by a professional exposed to the stressor (e.g. first responders)
• Persistent and intrusive re-experience of the event through memories, nightmares, flashbacks (e.g. dissociative reactions), distress after exposure to a reminder of the stressor, and physiological reactivity after exposure to a trauma-related stimuli (e.g. jumping up after hearing a door bang unexpectedly)
• Avoidance of distressing trauma-related stimuli, including thoughts or feelings, and/or trauma-related external reminders such as situations or people
• A negative effect on thoughts and mood, including an inability to recall features of the trauma; persistent negative beliefs; persistent and distorted self-blame and/or blaming others; persistent negative emotions such as fear or anger; diminished interest or pleasure in activities; feeling detached or estranged from others; and having a persistent inability to experience positive emotions
• Alterations in physiological arousal or reactivity including irritable or aggressive behavior; self-destructive or reckless behavior; hypervigilence; exaggerated startle response, problems in concentration, and/or sleep disturbance
• Distress or functional impairment in relationships, social, and occupational roles

What PTSD Feels Like

PTSD doesn’t always occur immediately after the traumatic event. In fact, in some cases, the diagnosis may not be made for up to six months with the gradual onset of the full symptoms. Some individuals with PTSD develop dissociative symptoms as the primary feature of the condition. Those affected describe a sense of being an outside observer or detached from oneself (depersonalization), and/or the sense that things are not real or are distorted (derealization). See the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition for a detailed description of the diagnostic criteria for PTSD.

Unfortunately, PTSD predisposes affected individuals to other behaviors that can be emotionally and physically harmful. Persons with PTSD are more likely than persons without PTSD to develop alcohol use disorder (AUD) and substance use disorder, including tobacco, pain medications, and illicit drugs. Nearly half of people with PTSD can suffer co-occurring depression. Physical symptoms and conditions associated with PTSD include cardiovascular conditions such as hypertension, pain, gastrointestinal symptoms, and musculoskeletal symptoms.

While it is very difficult to predict who will develop PTSD, some factors may increase the risk of developing the symptoms, including:

• Getting physically hurt during the trauma
• Seeing another person get hurt or killed
• Having childhood trauma
• Having a sense of horror or helplessness during the trauma
• Having little or no social support after the event
• Dealing with additional stressors after the event, such as losing a loved one, ongoing pain or injury, or loss of one’s job or home.

Taking Care of Oneself after Trauma

While trauma impacts everyone differently, there are some ways to reduce the risk of developing PTSD. Examples include:

• Seeking out support from other people, including friends and family
• Talking about the trauma soon after it occurs
• Attending a support group with others who may have had similar experiences
• Learning how to acknowledge and accept your actions in the face of the trauma
• Having a positive coping strategy; being able to act and respond effectively despite feeling fear

PTSD does not have a cure, but symptoms can be managed to help an individual function better in day to day life. The recommended treatment of PTSD largely is based on the use of medication and psychotherapy. The earlier treatment is started, the more likely the treatment will have positive effects. Combinations of medication, psychotherapy and support are typically the most effective way to ameliorate symptoms.

Therapy for PTSD

Several therapy types have been shown to reduce the physiologic responses to stimuli, or alleviate intrusive thoughts by teaching a person the skills to identify triggers in order to better manage their symptoms.

• Cognitive behavioral therapy has been shown to be effective in treating PTSD. In addition to educating people of their symptoms, cognitive behavioral therapy can also include prolonged exposure (PE) therapy to address the traumatic event. During PE one gradually approaches trauma-related memories, feelings, and situations that have been avoided since the trauma. By confronting these challenges, PTSD symptoms decrease.
• Novel treatments for PTSD include Eye Movement Desensitization and Reprocessing (EMDR). This is a form of psychotherapy that involves the patient paying attention to a back-and-forth movement or sound while thinking about the upsetting memory long enough for it to become less distressing. During EMDR, one learns about their physical and emotional reactions to trauma, targeting the upsetting memory, discussing the memory, and ultimately focusing on a positive belief or feeling while the memory is in one’s mind.
• Cognitive restructuring or processing therapy helps the affected person work through faulty memories of the trauma, and challenges their interpretations of the event, experience of the event, and beliefs that life is full of ongoing danger. Cognitive processing therapy teaches new ways to handle upsetting thoughts and to develop a new perspective on both past and future.

Other therapies include training in relaxation and anger-control skills, group therapy, couples therapy, family therapy, implementing an exercise program, and sleep hygiene. While often tempting in the short-term, it is essential to avoid self-medication with alcohol or other substances such as pain killers that often are habit forming, and may exacerbate symptoms.

When approaching our programs, we at Magellan recognize the importance of identifying PTSD symptoms early on. We hope to spread the understanding that one’s response to trauma does not reflect failure, or weakness in character. Rather, we believe that raising awareness and understanding of PTSD is essential to tackling this condition, which affects so many Americans. As we move forward in developing and integrating new programs, we are keenly interested in supporting individuals, families and healthcare providers to increase access to resources for PTSD education, treatment and support.

Looking for more information on PTSD support? Click here for a list of resources and tips, or call 1-800-273-TALK if you are in crisis.

During National Depression Awareness Month, we wanted to take some time to discuss the very normal stress and mental health challenges working families experience as we are increasingly connected to our jobs. As our connectivity to work has grown – between email, texting, chats, phone calls, video conferencing calls, and a myriad of social networking sites – so has the challenge to separate work from our personal lives. Employees are spending an increasing amount of time both at work and thinking about work. Habits such as checking email during a family dinner or ruminating about that email that you’d forgotten to write in bed at night are common experiences for many. Add on top of that a child who’s acting out and a parent who needs a little extra care both physically and financially, and you have a recipe for stress that affects your own health and mindset, as well as potentially relationships with family, friends or colleagues.

Employee assistance programs (EAPs) have been adopted by many employers to reduce the impact of mental health disorders, workplace stress and other work/life issues on workplace productivity. Despite the ubiquity of this employee benefit, which is offered by 97 percent of large employers, utilization hovers around five percent industry-wide. A primary barrier is the stigma of utilizing EAP programs, which were historically grown from occupational substance abuse programs.

While great strides have been made in reducing stigma, a great opportunity lies in changing the premise that stands in the way of employees tapping into services that might help them move forward and find their best self. What if we were to fundamentally remove the premise that there are people with “issues” and people without? The reality is that every employee is faced with their own brand of “juggle,” and stress and anxiety continue to be on the rise as working families live increasingly busy lives.

As Magellan transforms the EAP benefit for modern day workers and their families, we’re driven to provide resources and tools to help people address their mental health challenges before they severely impact their lives and productivity. The pivot lies in helping employees take care of their mental health as a practice of self-improvement and in helping employers position EAP services in their culture of well-being.

There are three essential components to powering this shift in the transformed EAP:

• Clinically-validated online programs and mobile apps that help employees track and change habits and mindsets
• When employees experience a bump in the road, convenient access to a coach or therapist that can fit into their harried day
• Content that inspires, motivates and helps employees feel validated in the normalcy of their stress and feel connected to others tackling similar experiences

Imagine a world where employees give each other a high five for taking some “me” time, leveraging a convenient method of choice, just as they do for someone sticking to their gym routine or running their first 5k. We certainly do!

“We are often asked in interviews what our most memorable experience has been as a pharmacist,” said Marc. “I used to have a go-to story I thought was amazing, but now that story has been replaced.”
Marc Ream
Clinical Pharmacist, Magellan Rx

This month, we’re celebrating our amazing pharmacists and the work they do to impact members at virtually every point along the patient-care continuum. Today we’re sharing a story from clinical pharmacist Marc Ream, who partnered with the commercial pharmacy team to go above and beyond the call of duty for a family in need.

Although he did not know it then, when Marc Ream took a call late on a Friday afternoon, he was about to experience what would become the most rewarding moment in his career as a pharmacist.

The call came from a mother with an urgent request for an oncology drug approval for her 10-year-old daughter, Jane.* Jane, who lives with Leukemia, needed a specific medication that is relatively rare and not easily accessible. The family was leaving on their long-awaited vacation the next day, so they needed the medication that same day. Marc quickly realized that  getting this medication to the member quickly would require collaboration with the prescribing oncologist, as well as with multiple parties including the health plan, account managers, technicians, pharmacists, physicians and the dispensing pharmacy.

Marc quickly went to work, placing a call to the prescribing oncologist to gather a comprehensive history on the young girl, as well as the necessary clinical rationale to make the approval. Typically, once a medication is clinically approved, the pharmacist’s job is complete and the prescription can be filled by a local pharmacy. However, this particular oncology drug was classified as a limited-distribution medication, typically dispensed only through mail-order facilities. Realizing that the family would not have time to wait, Marc contacted a specialty pharmacy in the area to try to come up with a quicker solution.

He reached out to the pharmacy’s lead oncology pharmacist and confirmed that the medication was in stock, and they conferenced in Jane’s physician to place the order.  Marc worked with the oncology pharmacist to schedule delivery of the medication to the family. When they called the mother to tell her the good news, they could hear the emotion and gratitude in her voice. Thanks to the swift and diligent work of many, Jane and her family were off on their dream vacation with this important medication in hand.

Thank you to Marc Ream and the commercial pharmacy team for this empowering story that shows just how passionate and committed we are to leading humanity to healthy, more vibrant lives.

*Details around the specific circumstances of this story have been changed to protect the identities of both Jane (not her real name) and her family.

Today, children and adolescents with behavioral health challenges are generally prescribed, and use, an alarming number of psychotropic medications. This excessive usage has raised concerns among families, practitioners and advocates amid questions about the appropriateness of the diagnoses that justify the drugs’ use – as well as the uncertainty surrounding the long-term effects of these drugs on a child’s neurological development.

Thinking ahead about the challenge

Magellan Health has had its eye on this issue for years, publishing a popular monograph, “Appropriate Use of Psychotropic Drugs in Children and Adolescents,” on the topic in 2013, which addressed the anxiety and confusion around the issue. Now – leveraging new data and research – we have released an updated monograph.

We know that appropriate use of psychotropic medications can play a role in helping children and youth with behavioral health conditions successfully live at home, achieve in school and experience positive engagement within their communities. But first parents, caregivers and practitioners need to fully understand the risks and monitor their use. When they’re used in the wrong way, these drugs can lead to a host of medical conditions and social problems that prevent youth and their families from achieving their goals.

10 questions to ask before starting treatment

To tackle this issue in the most practical way, we’ve developed a list of top 10 questions for caregivers, practitioners and the child/youth to discuss before beginning this type of treatment:

The treatment options

1. Are these medications needed?
2. Will the child benefit from therapy?
3. Did the child get a full evaluation from a behavioral health practitioner?

The medication

4. Has the medication been tested and approved for children? What are the risks, benefits and side effects?

The treatment plan

5. How will we know the child is making progress?
6. How often will the child be checked after starting the medications? What happens if we don’t see progress?
7. What warning signs should we look for and when should the doctor be called?
8. Will the treatment be noted in the child’s health care records?
9. Will the practitioner talk to the child’s other health care providers?
10. Does the practitioner know of other medications the child is taking and are there risks in combining them?

Implications

We know practitioners strive to do the right thing for the individuals they serve. With our monograph, we aim to support them in their decision-making process. Our approach is to help primary and behavioral health practitioners – as well as parents, youth and advocacy organizations – make informed decisions that most effectively meet each child’s needs. When the right medications are prescribed and monitored, they can have positive results in a child’s life.

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.