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Being a parent is one of the most challenging and rewarding jobs an individual can hold. When behavioral health challenges are added, it becomes even more difficult. Try, for a moment, to imagine being a foster parent to a child with behavioral health challenges. Where does one even begin to find the help and services they need to best care for their child?

Through our collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan in Wyoming coordinates care, including behavioral health interventions with other youth serving agencies in our system, using the High Fidelity Wraparound (HFWA) model to build a team of support for the successful management of complex conditions and behaviors in home- and community- based settings. The team creates steps to help youth stay in their homes, schools and communities. Through the 10 guiding principles of the program, families and youth have a voice in their care and choice in the kind of care they receive. We help to strengthen community support, understanding, and education of at risk youth ages 4-20 with complex behavioral health needs.

Magellan in Wyoming recently had the opportunity to hear from a former foster parent and HFWA graduate to discuss how the program benefited them through their challenges and supported their growth. “Opening my heart up to love and attachment with these children, parenting them with unconditional love, all the while knowing, they might not stay was difficult,” said the foster parent.

The siblings involved and their foster family cycled through numerous foster care workers in three years, creating more trauma for everyone. There was no stability and no consistency. Dealing with several different mental health diagnoses and many weekly appointments, in addition to the strain of everyday life, took a toll.

When this family discovered HFWA, they were naturally a little skeptical. They had experienced enough “new” things; however, this was the beginning of a completely new outlook on life. From the very start, HFWA taught the foster parent that it was okay to take a breath, to sleep and to ask for support. More importantly, it became evident that people wanted to help and be on the family’s team to help support them.

The family had spent so much time triaging the risk aspects of their children’s lives, that it had drained them of most of their hope. Through the strengths-based principles of the HFWA program, the family was able to gain new insight into ways they could focus on the local supports available to help them.

The program taught them to see the progress. By forming a HFWA team around the foster children and the whole family, they were able to gain some positive, strengths-based perspective along with stability and consistency.

HFWA empowered the family to have a voice and to use it effectively. “I knew all the people on my team before HFWA, but the program taught me how to use my voice. It taught me how to say what was going on and who to say it to,” said the foster parent. It was because of the family’s team, as well as community investment in the program, that today, the family is enjoying a life full of hope and possibility.

To mark Mental Health Month, we had the opportunity to sit down with Dr. Caroline Carney, chief medical officer of Magellan Healthcare. Dr. Carney shed some light on stigma, barriers to mental health services and ways we can all help all friends and family get the treatment they need to live a healthy, vibrant life.

Why is there still a stigma around seeking help or treatment for mental health concerns?

Dr. Carney: I think we first need to talk about what stigma is, and where it comes from.

Unfortunately, people with mental illness have been stigmatized by others, and even by themselves. Mental illness is often still perceived as an indulgence, a sign of weakness, or as a character weakness. You also may find people who believe mental illness is something that is scary, or to be made fun of. So many myths exist about mental illness, including that it is the result of bad parenting. Popular culture continues to further the stereotypes and myths.

Further, self-stigmatization is a huge driver for this. Self-stigmatization occurs when shame and secrecy override even the most extreme of symptoms, preventing people from getting the help they need. Few people recognize how prevalent mental illness is.  We don’t talk about depression. We don’t talk about our own perceived failures. We don’t talk about how tough life can be, and often suffer through it in silence. Further, the symptoms themselves, whether depression, anxiety or psychotic disorders, often contribute to a sense of isolation. In the time of Facebook and Instagram, we are led to believe that everyone lives a happy and interesting life every day. If you feel you don’t measure up to what is shown on social media, it can then be perceived as a failure. This is especially true for adolescents, teens and college-aged kids. I’ve spoken recently to a young person who was afraid to talk to her best friend and to her mentor about her feelings of depression and loneliness. She was afraid they would think that she was weak and flawed—therefore not worthy of being a good friend. Instead, she suffered in silence, further worsening the symptoms until suicide became part of her daily thoughts. Most people around her would never recognize this incredible kid regularly thinks of suicide. This, unfortunately, is an all too common scenario.

What can friends, family and coworkers do to help lessen that stigma and encourage people to seek help?

Dr. Carney: I think the biggest step is to support and withhold judgement. Family and friends need to be upfront about symptoms or conditions they’ve had in their own lives. I often advise that it is a normal, common thing to get treatment—it should be considered no different than getting treated for any medical condition. In some cases, friends and family may find themselves helping someone access treatment at a mental health provider or a primary care physician. Emphasizing that mental illness isn’t a sign of failure, and can actually be treated, is critically important. As a doctor, I have often counseled the loved ones of my patients that it can be frustrating to take care of a person in the thick of an episode of mental illness. The symptoms of depression, for instance, dampen ones motivation, support beliefs of hopelessness, and take away energy. It should be no surprise, then, that the person suffering from mental illness doesn’t want therapy. Don’t give up on them—understand that the disease itself influences getting treatment.

Treatment for mental illness doesn’t happen overnight—it can often take weeks or even longer for a response to occur. Family, friends, coworkers, and providers shouldn’t give up.  Look for incremental change, not overnight cures.

What is the biggest misperception about mental illness? 

Dr. Carney: The biggest misperception is that mental illness isn’t an illness—that is something one brings upon oneself. Mental illness is caused by biological, genetic, and environmental factors.

Can you live a life of recovery?

Dr. Carney: Absolutely! Because mental illness is a medical condition, it’s important to know about different mental conditions and their associated treatment options. A common myth is that the illness will go away if a stressor is removed, or time passes, or a person just thinks positive thoughts or prays. Think about a physical illness such as diabetes. Diabetes won’t go away with positive thinking, and neither will a condition like depression. Mental illness can be treated, and the earlier treatment is initiated, the better the chances of recovery. Finding licensed, trained providers is essential. Using social supports like faith or your peers can be an extension of, not a replacement for, treatment.  Importantly, having an episode of depression or an anxiety disorder may only occur once in a lifetime. If the root causes are uncovered, cognitive distortions are addressed, and if appropriate, medication used correctly, the morbidity of mental illness can be markedly reduced, and may never come back. Even people with serious persistent mental illness, such as schizophrenia, can live a life of recovery with the right supports and treatment.

But I also think it’s essential that we need to educate people that the illness may return. This doesn’t mean that a person with mental illness failed. It means that the illness may be chronic, but the symptoms can still be treated.

The most vital concept to remember is that recovery is possible, and can be permanent.  When it’s not permanent, treatment can be ongoing and very successful.

What can providers/clinicians do to help reduce stigma?

Dr. Carney: I think there are a few ways that everyone – not only providers or clinicians – can help counter stigma around mental illness.

• Know the facts about mental illness—read about mental illness from expert and advocacy groups like the National Alliance on Mental Illness (NAMI), the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration (SAMHSA) and other sites.  Rumor and innuendo never serve the facts.
• Continue to reinforce that this is an illness, and not a sign of weakness or failure.
• Take a look at your own attitudes and how you think about mental illness—whether your own, in someone you care about or the stranger you see on the street.  Understand that no one would ever want to be depressed, or be troubled by hallucinations. Mental illness is an illness, no less than heart disease or cancer.
• Choose your words carefully—Often we refer to someone who has diabetes as a diabetic, or a person with schizophrenia as a schizophrenic. People are more than their disease, whatever it may be. We need to preserve personal dignity by recognizing that our words matter—use terms like “he is a man with schizophrenia,” and be mindful of common phrases like “crazy” or “nuts.”
• Provide support by keeping your loved one or friend safe from harm. Participate in therapy when asked. Avoid passing judgement, especially about how quickly someone’s recovery may be progressing, and continue to support the receipt of treatment.
• Take an honest look about what environmental factors may be contributing to the illness.  Evaluate short-term and long-term stressors.  Just like we would monitor the diet for someone with diabetes, we should recognize that environmental factors contribute to mental illness, just as they do to physical health.
• Never accept or foster stereotypes.

When I was selected to join the National Quality Forum’s Medicaid Innovation Accelerator Project Coordinating Committee, I thought about the background and experiences I would bring with me – both personally and professionally. As a trained pediatrician, my medical training focused largely on the care and treatment of young children. According to the Centers for Medicare & Medicaid Services (CMS), more than 45.2 million children were “ever-enrolled”¹ in Medicaid and the Children’s Health Insurance Program (CHIP) during fiscal year 2015. In addition, in the time since I was in practice, I’ve worked for several national healthcare companies, with a focus on population health, clinical delivery systems delivery and improvement.

Since joining Magellan as the company’s chief medical officer, I’ve worked with my colleagues to help continually looks for ways to reinvent how care is delivered. I am passionate about supporting the volume-to-value payment transformation, and Magellan has a key role to play because of the deep expertise we bring in behavioral health. Oftentimes, we don’t realize how specialized and important that expertise is, and how it impacts the overall quality of care for a patient, particularly with comorbid conditions. Magellan is also considered a trusted partner because we are an independent company and not part of a big health plan. In addition, we also bring a breadth of experience in medical specialty, medical pharmacy and long-term services and supports (LTSS) which is not found in most other organizations.

NQF’s Medicaid Innovation Accelerator Project (IAP) Coordinating Committee is tasked with identifying and recommending measures in four priority areas to help support states’ efforts related to payment and delivery system reforms.

The four priority areas are:

• Reducing Substance Use Disorders (SUD)
• Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs (BCN)
• Promoting Community Integration – Community-Based Long-Term Services and Supports (CI-LTSS)
• Supporting Physical and Mental Health Integration (PMH)

The challenges – and opportunities – are many. Medicaid behavioral health does not currently have standard benefit packages from state-to-state, and there are also not standard billing practices. Both of those elements make it much harder to develop metrics which are reliable, and more technical expertise is needed to ensure that the metrics selected can be broadly used. Ultimately, this committee will provide guidance on performance measures for areas which are unique to Medicaid, including patients with complex health needs, LTSS needs and those with behavioral health and substance use/opioid disorders. The states will then have a list of standardized measures for use in Medicaid performance program evaluation.

All of the committee’s meetings are open to the public. The IAP will issue its draft report in July, and its final report at the end of September. I look forward to working with my committee colleagues as we work to draft these important metrics related to state’s efforts regarding payment and delivery system reforms.

¹These enrollment data are unduplicated counts of children who were enrolled in Medicaid and CHIP at any point in FFY 2015. A child who was enrolled in more than one program (e.g., Separate CHIP and Medicaid) at different times during the FFY is only counted in the program in which he or she was last enrolled.

Between January 30 and February 1, Magellan hosted its Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. Our annual gathering of healthcare insiders, experts and leaders provides opportunities for key members of the industry to talk openly about the future of healthcare. You can read part one of our review of the 2017 event here.

Building and Planning for the Future

Day two keynote speaker, Salim Ismail, chair of ExO Works, best-selling author of Exponential Organizations and former executive director of Singularity University, gave a fantastic overview of the exponential business model and how it applies to healthcare. Pointing to a wide variety of other industries, Ismail showed that disruption is powerful, creating both problems and opportunities. If a company fails to respond, it can quickly become overwhelmed — case in point, the photographic industry’s reaction to digital cameras. When the public embraced digital imaging, the market for film and film development disappeared; however, a whole new slew of problems arose allowing opportunity to flourish. In this case, the large number of images created by the average person needed new solutions, namely how to store and organize their digital pictures.

Ismail explained that there was a doubling pattern of exponential growth in a basket of many technologies. He also pointed out that humans are, in fact, not very good at accepting exponential growth. Our brains do not track exponential growth well, preferring scalable efficiency. Ismail gave advice on how companies (in healthcare and beyond) can prepare themselves to not just deal with exponential change but to lead it. Michael Guyette, president and CEO of Blue Cross and Blue Shield of Minnesota (BCBSMN), gave some key insights into how that spirit of disruption and innovation can look in the healthcare world. Guyette relayed how BCBSMN had created a unique program focused on innovation and diversification that has resulted in ways they can improve the health of communities they serve. “You need to have focus. Otherwise, you’re just going to go all over the place with innovation,” Guyette said. “But we as leaders need to make sure that we embrace our legacy while we start to reach out for the change of the future.”

Big Data Leading to More Personalized Care

One particularly interesting discussion centered on the rise of big data. While the concept of data-driven healthcare may seem impersonal at first glance, several voices argued that it can actually lead to more personalized care. For example, Michael Neidorff, chairman, president & CEO, Centene Corporation, brought up software that track genetic and genomic patterns. This data can be used to map cancer at the individual level, allowing for personalized care. Similarly, the ability to collect and process personal health data was brought up by Seth Dobrin, vice president and chief data officer at IBM Analytics, as a powerful and personal disruption of the health care industry.

Brian Flanigan, principal at Deloitte Consulting, brought up the fact that healthcare is in an affordability crisis. 76 percent of consumers rate the healthcare system as poor or average and costs are rising to unaffordable levels. Flanigan pointed to the use of innovation and data to provide the high-level, personalized services that consumers demand at more affordable prices. Using data and new technology, Flanigan pointed out, will literally allow us to do more for less.

Discussion with Peers and Experts

When we first developed the Magellan Open Vision Exchange, we wanted to avoid the typical corporate conference format and create a genuine exchange of ideas and experiences between healthcare peers and insiders. Once again, we were thrilled with the level of dialogue, questions and answers that we heard from our speakers and panelists.

Magellan’s collection of HEDIS (Healthcare Effectiveness Data and Information Set) quality measures for 2017 has entered the final phase of data collection. You’ve probably heard of the acronym HEDIS – but what does it stand for and what does it mean to you? The Healthcare Effectiveness Data and Information Set – HEDIS — was created by the National Committee for Quality Assurance (NCQA) to measure the clinical quality performance of health plans.  This is accomplished through the collection and analysis of data documenting the clinical care received by individual plan members from providers, influenced through activities and programs delivered by the health plans.  The data is aggregated and reported collectively to reflect the ‘collective’ or population-based care received by the plan’s membership.  These reports have become a major component of quality rating systems that measure the clinical quality performance of health plans by Centers for Medicare & Medicaid Services, states offering Medicaid and other entities. Right now, Magellan has entered the final phase of data collection for HEDIS quality measures for 2017.

There are 91 HEDIS 2017 measures, but it’s important to note that the number may vary from year to year as new measures are added to the set and some are retired. The measures cover many aspects of healthcare including preventive care such as screening tests (e.g., mammograms) and immunizations, management of physical and mental health conditions, access and availability of care, patient experience, utilization and relative resource use.  Data is reported individually for each product and line of business

Measure data is collected is a variety of ways.  Claims are the major source of data, but specific measures may also allow plans to survey members or to access member medical records for additional data not captured in claims.  This type of data collection (combined claims and chart data) is called hybrid.  The final phase of data collection for health plans choosing to do hybrid runs from January through May and is often called MRR for medical record retrieval, or simply ‘chart chase.’  Final HEDIS data covering services rendered in 2016 and prior will be submitted to NCQA by June 15, 2017.  Final health plan ratings for all lines of business are published on the NCQA website by October 2017.

For health plans, HEDIS ratings can be very important. The scores on measures can help them understand quality of care being delivered to their members in some of the most common chronic and acute illnesses.  Higher scores can help compete more effectively in various markets. HEDIS score reporting are often required in public markets as well, where the results are often reported to the states, or occasionally counties, in which the plans reside.

Behavioral health and pharmacy are well represented in the HEDIS measure set. Behavioral health has multiple measures that include ensuring continuity of care, appropriate psychotropic medication management/adherence, and initiation and engagement of drug and alcohol abuse treatment.  Pharmacy measures focus on medication management of acute and chronic physical and mental illness, appropriate medications in the elderly, and management of polypharmacy.  Specialty measures are directed toward inappropriate imaging.

So, what is the value of HEDIS to Magellan?  Aside from being a collection and reporting contract requirement for many of our customers and our own health plan, HEDIS gives Magellan valuable information about the populations we serve.

By following the behavioral health data, we collect, for example, we can identify gaps in network performance in patient follow-up patterns, management of drug and alcohol abuse, and prescribing and adherence to medications.  This allows us to design and implement interventions that can improve outcomes and reduce cost of care.

The same type of analysis/intervention applies to physical health conditions.  Analysis of HEDIS data helps identify gaps in care, particularly preventive care, in such important and chronic populations as patients with diabetes mellitus, patients with cardiovascular disease, and patients with lung disease.  We can also identify and address at-risk pediatric populations who fail to complete preventive care such as immunizations, dental and well-child care.

As the healthcare industry moves more and more toward value-based purchasing, all providers, insurers and their vendors are necessarily increasingly focused on the quality of care that is delivered.  The impact of this should be better outcomes for our members.

Find more articles about NCQA here

Thirty years ago, President Ronald Reagan deemed March to be Developmental Disabilities Awareness Month. Awareness months are an important advocacy tool, as they provide opportunities to reflect on progress and continue meaningful conversations about the future. For many people with developmental disabilities, ensuring these discussions take place can be the difference between being invisible and living as full citizens in their communities.

Developmental disabilities awareness is something near and dear to me, not only as the president of TMG by Magellan Health—supporting the largest self-directed long-term services and supports program of its kind in the country—but also because of my graduate work. During my practicum, I worked on the South side of Chicago, assisting low-income families who had children with developmental disabilities. Too often, these families, many of them single mothers, struggled to find the necessary services to help their children live as independently and inclusively as possible. The isolation the children experienced was heartbreaking.

Fortunately, in the 20 years since then, I’ve seen wonderful strides in the resources available for people with developmental disabilities, as well as greater expectations for community inclusion. Self-direction has played a crucial role in this progress. With self-direction, individuals choose not only the services they receive and who provides them, but also how they live their lives. This means people have control over things many of us take for granted: living where and with whom we want; making our own schedule; having meaningful, lasting relationships; pursuing our hobbies and passions; and finding meaningful work or volunteer opportunities. There’s been an amazing nationwide movement towards self-direction, which is not only a best practice, but also the cornerstone of TMG’s work in Wisconsin’s innovative IRIS (Include, Respect, I Self-Direct) program.

While there’s been great progress in raising expectations and increasing opportunities and resources for individuals with developmental disabilities, there’s still much to overcome on the path towards greater acceptance and inclusion. Thankfully, as community inclusion and self-direction are becoming more commonplace, society increasingly recognizes the contributions that people with developmental disabilities can make. As a leader in helping individuals create healthy, vibrant lives, Magellan Health is at the forefront of self-direction with its Wisconsin program, and is building a strong self-direction component in its new managed long-term services and supports (MLTSS) program, Magellan Complete Care of Virginia.

So as you make your way through March, take time to think about the people in your life and in your community and how we can all support one another. Learn how to be a better advocate for individuals with disabilities at sites such as ACL.gov and NACDD.org, and read stories of self-direction in TMG’s The Path Ahead. Encourage and support inclusion and independence whenever you can. But mostly, take the time to get to know people for who they are and appreciate their individual gifts and talents.

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.