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

Tips for all ages

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

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

Tips by age group

Preschool age

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 They may have tantrums or cry more than usual, or become withdrawn from others.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

Early childhood

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

Adolescence

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

When to get help

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best practices for a complex challenge

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

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.”

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 Haita Makanji, vice president, clinical specialty solutions, was featured in Managed Healthcare Executive this week, discussing some ground breaking new gene therapies that are available for hemophilia sufferers. These therapies promise the potential of fewer infusions and bleeding episodes.

You can read the complete article at Managed Healthcare Executive by clicking here.

As we look back on 2017, it was a year of many milestones on the United States (U.S.) drug approvals front. With 46 novel drugs receiving Food and Drug Administration (FDA) approval, it reached a 21-year high and more than doubled novel drug approvals in 2016. This count does not even include a number of biologics, vaccines, cell-based therapies, and the first ever, direct gene therapy for a hereditary disease.

Among the historic clinical highlights of 2017 was the landmark approval of two CAR-T therapies, tisagenlecleucel (Kymriah™) and axicabtagene ciloleucel (Yescarta™), for select types of leukemia and lymphomas, respectively. CAR-T or chimeric antigen receptor-T (CAR-T cell), is a multiplex process where a patient’s T cells are harvested, genetically modified, and infused back into the same patient to fight cancer cells. 

The role of specialty pharmacies in the invoicing construct for these costly CAR-T therapies is a fascinating component of these new treatment modalities. As illustrated in the CAR-T Invoicing Flowchart, the product is shipped directly from the manufacturing facilities to the certified hospital or treatment facilities. Once the certified hospitals take ownership of the product, they bill the payers who, in turn, pay the certified hospitals. The specialty pharmacies serve as the billing wholesaler between the manufacturers and the certified hospitals to invoice the hospitals and, ultimately, deliver payment to manufacturers. In this unique model, the specialty pharmacy does not handle the drug; rather, it serves as the invoicing clearinghouse between manufacturers and certified hospitals. Hence, there is no interaction between the specialty pharmacy and payers.

Specialty pharmacies are at the epicenter of care for patients with complex conditions. As a high-touch resource, they operate in a clinical environment that leverages specialty pharmacies’ services to dispense, distribute, provide monitoring, case management, adherence programs, reimbursement, and a number of other services particularly for patients with complex and rare diseases. In the CAR-T invoicing construct, the specialty pharmacy takes on the exclusive role of shepherding the invoice.

As we look ahead, future complex therapies will present a new paradigm for all stakeholders including prescribers, pharmacies, payers, patients, hospitals, and regulators. Specialty pharmacies, as an invoicing liaison, may be yet another facet in the evolution towards the next frontier – Specialty Pharmacy 2.0.

Today, much of the conversation around opioid use focuses on ways to more tightly control access, including limits on usage and the mandatory use of databases that can alert physicians to patients’ opioid histories. But for those suffering from Opioid Use Disorder (OUD), combatting addiction is a difficult feat, particularly due to treatment barriers, lack of qualified providers, and waitlists for evidence-based treatments.

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