Stacy Ellingen is a woman from Wisconsin who’s never met an obstacle she couldn’t overcome. After graduating from high school, Stacy left home to attend the University of Wisconsin-Whitewater. After graduating with a degree in journalism and advertising, she moved to Oshkosh. Now in her thirties, Stacy leads a busy professional life as a small business owner and an independent contractor with InControl Wisconsin, an organization that plays a key role in advancing self-directed supports in the state. She’s become more involved in disability advocacy efforts and the community.

Stacy’s story is a successful one—living independently for more than five years, finding a job about which she is passionate and becoming involved in her community. But now consider this success as part of Stacy’s larger story – she grew up with cerebral palsy, resulting in complex physical support needs. However, Stacy grew up believing that she could do everything others do. Working with her self-directed support consultant, Kathi Miller, an employee of TMG by Magellan Health, Stacy proved she could do everything others do.

“Kathi has helped me reach my goals in many, many ways,” Stacy said. Kathi and Stacy joined forces to identify community home care providers to support Stacy in meeting her daily needs at home and at work. They partnered to identify ways that Stacy could make responsible budget decisions in purchasing services to meet her goals. When developing her small business, Kathi supported Stacy in connecting with the local business community to create professional peer connections that enhanced her business development strategies. “Most of all though, Kathi encouraged me to keep moving forward when things got tough! She has been amazing!” said Stacy.

Download a copy of this infographic here.

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.

According to the Kim Foundation, one out of four Americans experiences behavioral health issues. Of those, 60 percent are not receiving treatment.

Why are so many people not receiving treatment?

What does this mean for providers?

What more can be done to increase access to behavioral healthcare?

Learn more about this issue by downloading Magellan’s new infographic, “Mind the Gap: Increasing Access to Behavioral Healthcare.”

Opioid addiction kills thousands of people every year. In 2014, for example:

• There were 18,893 overdose deaths related to prescription painkillers
• There were 10,574 overdose deaths related to heroin

Despite these shocking numbers, the problem continues to grow. (It quadrupled in the first decade of this century and continues to explode). In the past twelve months, the Drug Enforcement Administration (DEA) has been forced to issue new warnings on drugs such as fentanyl, a potent opioid more than 100 times more powerful than morphine and 30-50 times stronger than heroin. While fentanyl has killed thousands of people over the past few years, many only heard of it recently, when it was attributed to the death of the musician Prince.

Close to Home: Opioid Addiction from Prescription Sources

Given the dangerous nature of some of the most common prescription painkillers—not just from concerns about addiction but from accidental and intentional overdose (the leading cause of accidental death)—it may be surprising to find out just how common it is to find opioid medications in the home.

In 2012, the Centers for Disease Control (CDC) calculated that healthcare providers wrote 259 million prescriptions for opioid painkillers. That is enough for every American adult to receive a bottle of pills.

While there have been efforts to reduce the number of prescriptions written, the number of prescriptions remains very high and the volume of opioid medications already distributed is also alarming.

And this is a key contributor to the opioid addiction crisis. According to the CDC, most people who abuse prescription opioids get them for free from a friend or relative. Essentially, people give their old prescribed medications to friends or relatives. Or, alternatively, abusers take old prescription pills from friends and relatives without their knowledge.

Even among the people at the highest risk of overdose (using prescription opioids non-medically 200 or more days a year) a friend or relative’s medicine cabinet is a common source of finding opioid medications. Among that population:

• 27 percent use their own prescriptions;
• 26 percent get them for free from family or friends;
• 23 percent buy them from friends or relatives; and
• 15 percent buy them from drug dealers.

Cleaning Up: Reducing the Availability of Prescription Opioids

Since the early years of the decade, state and federal authorities have made a concerted effort to reduce the regularity by which opioid medications are being prescribed. In particular, there has been a focus on reducing the ability of abusers to use multiple prescribers to issue painkillers.

Several states have achieved various degrees of success. In New York, the number of patients seeing multiple prescribers for painkillers was reduced 75% percent between 2012 and 2013 after prescribers were required to check the state’s prescription drug monitoring program before issuing a prescription.

In the same time-frame, Tennessee saw a 36 percent reduction in the number of patients seeing multiple prescribers for painkillers when it instituted a program similar to New York’s.

Florida saw a 50 percent reduction in oxycodone overdose deaths between 2010 and 2012 after it regulated painkillers and stopped providers from issuing painkillers from their offices.

In addition to programs aimed at healthcare providers, the Federal government has directed resources towards educating consumers about disposing prescription opioids and other medications. The Food and Drug Administration provides information on the safe disposal of painkillers such as Fentanyl patches. The Drug Enforcement Administration is also providing information for the public regarding disposal as well as created a program to authorize and register drug disposal collectors.

A Pioneer in Substance Use Management

Magellan Health is a pioneer in offering integrated, comprehensive opioid risk and substance use management programs. We have an unyielding commitment to ending the current epidemic. And we are uniquely positioned to bring together behavioral, medical and pharmaceutical programs to positively impact overall population health and reduce cost.

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.