It’s hard to comprehend how much the world has changed since the beginning of the COVID-19 pandemic. It has turned our lives upside down in many ways, from school and business closures to quarantines and social isolation. With no clear end in sight, it is not surprising that many people are having difficulty getting used to the “new normal” that is far from what normal life once was.

Families face the challenges of online and home schooling, and the coming school year brings more uncertainty.  In addition, many people are experiencing financial strain from reduced working hours or job losses. Workers may have to work from home and adapt to an entirely new way of working, with little social interaction.  For some workers, juggling parental and domestic duties with the demands of work has been very stressful. Over time, chronic stress can lead to burnout.

Symptoms of burnout include feeling physically depleted, emotionally exhausted and negative about work.[1]

The signs of burnout are similar to those of depression. If left untreated, burnout can lead to physical illness and mental health problems, such as depression and anxiety. Here are some practical tips to manage burnout:

• Set boundaries between work and private life. If you work from home, set clearly defined working hours and a specific work area.
• Take breaks during the day and build transitions in your life between the start of work and the end of the working day. For example, making a transition to work can be as easy as getting a cup of coffee each day and logging into your computer at the same time. To end the day, practice a daily routine such as checking your emails, reviewing priority tasks for the next day and logging off your computer.
• Take your well-earned time off. Even if the pandemic kept you from going somewhere for vacation, a planned “staycation” will allow you to enjoy the well-deserved rest and relaxation. It is important to recharge; you will feel refreshed when you return to work.
• Don’t forget to socialize. When your colleagues start working from home, you may miss the casual social interactions had throughout the day. Like any skill, use it or lose it. Socialization in a time of pandemic takes effort to maintain.
• Make self-care a part of your daily routine. A healthy diet, getting enough sleep and maintaining an exercise schedule can help you cope with and reduce stress.
• Maintain consistent family routines. A regular routine can help all family members feel more focused and productive. If your child is at home learning online either full or part-time or you’re home-schooling, set consistent times for meals, schoolwork, other activities and bedtime.

Help is available. Your program is completely confidential and here to help you and your household members 24/7/365. No situation is too big or too small. Give us a call or visit your program website to get started.

[1] https://www.who.int/mental_health/evidence/burn-out/en/

Telehealth services have been available for years to help remove geographical and other boundaries for people in rural and medically under-served areas; however, use has been limited. Driven by the COVID-19 pandemic, including shelter-in-place orders, social distancing, and federal agencies mandating use for certain programs, telehealth has grown exponentially since March.

While companies like Teladoc and MD Live have been operating telehealth platforms for nearly two decades, many platforms are dedicated only to physical health. Magellan Healthcare has maintained a telehealth network for behavioral health since 2014 and helps:

• Health plans offer a cost-effective alternative to traditional doctor visits, urgent care and the emergency room; provide access to valuable care that is convenient and available anytime and anywhere; expand existing programs and services focused on health and wellness; and attract new members by offering the modern convenience of an on-demand service.
• Employers improve employee access to healthcare; reduce tardiness and absenteeism; increase employee productivity; offer a competitive benefits package; improve employee satisfaction; and retain and attract the best employees.
• Members have more privacy; access a deep and specialized network; receive treatment before work, after work or on weekends; have more frequent touch points to improve compliance with treatment and avoid unnecessary hospitalizations; and avoid travel, lost time from work and weeks of waiting for an appointment.
• Providers reach out to members in remote areas or where specialties are needed; provide care to homebound members; provide behavioral health services from home, office or while traveling; reduce no-shows and cancellations; offer additional and/or non-standard appointment times; and expand the patient base and improve relationships with existing patients.

Although the benefits of telehealth are many, people may feel uncomfortable using services. That’s why Magellan Healthcare created a video called Telehealth: Get Care and Treatment Wherever You Are. This video can help people understand:

• How to schedule a telehealth visit
• What to do once a telehealth visit is scheduled
• How to get the most from telehealth

The more comfortable people are using telehealth for their behavioral healthcare, the more options they have available to them. This can lead to improved compliance and better health outcomes.

Watch the video here.

In contrast to the conventional drug approval pathway in which drugs are reviewed under a New Drug Application (NDA), approval of a biological product is done under a separate pathway known as the Biologics License Application (BLA). Examples of biologics include therapeutic proteins such as insulin, monoclonal antibodies, vaccines, and blood-derived products. While the NDA and BLA processes are similar, they are not identical. The typical generic drug provisions (e.g., same active ingredient, bioequivalence) do not apply to BLAs. Instead, the single biological product already approved by the United States (US) Food and Drug Administration (FDA) is referred to as the reference product; the new potential biosimilar is then compared to the reference product. For approval as a biosimilar, the manufacturer must demonstrate that the agent is highly similar with no clinically meaningful differences.

In July 2018, the FDA released their Biosimilar Action Plan, described by then FDA Commissioner Dr. Scott Gottlieb, as “aimed at promoting competition and affordability.” Then, in December 2018, the FDA announced the plan to transition biological products that were historically regulated as drugs and approved via NDAs to the biologics pathway, taking effect in March 2020. These products include insulin, human growth hormone, and glucagon, among others. This change was mandated by Congress in the 2009 Biologics Price Competition and Innovation Act, which allowed 10 years for the transition. When considered as drugs under the NDA pathway, it was virtually impossible to develop a generic equivalent due to the nature and the inherent variation in the manufacturing process of these products. On March 23, 2020, the FDA issued a statement noting that this change is now in effect.

However, in the US, even if an agent is determined to be biosimilar, it is not automatically interchangeable (a process by which a product can be substituted for another without the approval of the prescriber). For a biosimilar to be considered interchangeable by the FDA, it must meet even more rigorous requirements and be approved as interchangeable. For products that are biosimilar but not interchangeable, the prescriber still needs to write for the specific product. In addition, even if determined to be interchangeable by the FDA, state pharmacy laws may further regulate what substitutions may be made at the pharmacy level without the approval of the prescriber. Just as a listing of generic equivalents is available through the FDA in their Orange Book, the FDA lists biologics and any respective biosimilars in their Purple Book. Recently converted to an online database format, the Purple Book provides details on reference products, their corresponding approved biosimilars, and whether or not the biosimilar is interchangeable. To date, no biosimilar has been designated as interchangeable.

As described in a previous blog post, the cost of insulin has risen substantially, leading patients to take desperate measures. At a time of economic instability and health uncertainty, these access concerns are even larger. Now that these products have transitioned to the biologic approval pathway, once patent exclusivity has passed, biosimilars can be developed, evaluated, and approved. Moreover, biosimilars can be reviewed further and may be classified as interchangeable, which can further alleviate the burden by allowing substitution at the retail level depending on local laws. This landmark change can promote market competition, potentially driving increased availability and decreased cost. The FDA reports that even having one generic drug on the market can decrease prices to approximately two-thirds of the price without competition. Generally, initial list prices of launched biosimilars have been 15% to 35% lower than their reference products. Most importantly, in their announcement of this change on March 23, the FDA pledged that they are ready to review eligible applications to ensure efficient approval. Ultimately, this revised process will provide an opportunity for other manufacturers to introduce safe and effective product competition without clinically meaningful differences. While this may be challenging in light of the ongoing global pandemic, this change, 10 years in the making, offers hope for patients who use these medications.

Being discharged from the hospital or receiving an unexpected diagnosis can feel lonely and confusing. What’s next? Where do I start? How do I manage all these follow up visits? What was I prescribed?

Data suggests that access to a collaborative team of a pharmacist and care manager can reduce hospital re-admissions by 50 percent. With our data-driven MRx Navigate solution, we are identifying members who might get lost in their care journey, helping to protect them from gaps in care and the risks of non-adherence, and guiding them along their path to wellness.

By fully integrating the many touch points of a member’s health and wellness, our team of clinical professionals works closely together to understand the member’s healthcare needs and assist them to better manage their condition through education, empowerment and specialized support. Our team provides seamless continuity of care and healthcare population management, delivering quality health outcomes and value-based savings.

Jill Anderle, RN, MRx Navigate Care Manager, describes her role by saying, “I care for patients and their loved ones who are often in extremely overwhelming circumstances. By listening closely and validating members’ concerns, I assess gaps in their treatment plan once they are discharged from the hospital. We also teach self-advocacy and connect people to supportive community resources to help prevent unnecessary hospital re-admissions.”

Mental Healthcare Manager Silvia Pantoja considers her role as multifaceted: “I help people who have recently been discharged from a hospital or mental health facility. Besides being a coordinator, educator, facilitator, and advocate, my main focus as a care manager is to empower patients by giving them a greater understanding of their disease.” Silvia helps connect members with therapists, psychiatrists, and other resources and stays in contact with each member to ensure they follow a clear discharge plan.

The MRx Navigate team has connections to extensive resources, helping members with durable medical equipment, like wheelchairs, scheduling follow-up appointments with specialists, and making sure the member’s home is safe and accommodates their new needs. The team’s clinical pharmacists provide drug information, answer questions about new medications, help find options for reducing the costs of drugs, and explain how to take medications appropriately and safely.

The wellness component of MRx Navigate, identifies opportunities for better care and increasing members’ quality of life through educational tools and preventive resources like bio-metric screenings, flu shot clinics, and mobile mammograms. Personal wellness coaches, like Baihly Birdseye, conduct outreach and health coaching. “Focusing on behavior change can not only help resolve illness, but it can also help member s avoid the hospital altogether, possibly preventing even more serious and costly complications. We also want wellness to be fun and engaging,” shares Baihly.

As the COVID-19 pandemic continues, and social distancing becomes the new normal, we have seen rapid expansion of digitally delivered peer and family support. In this post, we explore emerging issues and considerations for using technology to reach others.

The use of technology to offer peer support is a practice that has been around for quite a while. Think about telephonic peer support via peer-operated warmlines. A from December 4, 2019 said this about warmlines:

“Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis.”

Magellan has long been a supporter of peer-operated warmlines and has helped launch warmlines in multiple states.

You can find more information about warmline availability by state at www.warmline.org or by visiting the National Empowerment Center’s directory of peer-run warmlines.

As opportunities for in-person, face-to-face support have decreased, many peer-run organizations, along with traditional mental health providers, have shifted delivery of services to telehealth platforms. Yet, during this unprecedented COVID-19 public health crisis, we see increased demand for support from folks living with anxiety and depression. As more families are impacted by the pandemic, access to peer support is more critical than ever.

Peers have been quick to step up with a national grassroots-driven expansion of support via video conferencing platforms like Zoom. With this rapid expansion, however, we see wide variability in practices. Skills learned by providing in-person peer support do not necessarily translate onto a digital delivery platform. Individuals who are used to seeing a peer supporter in person may have a different experience when it’s offered through technology. In some cases, apps that purport to offer peer support are actually “peer-bots,” with real-time interactions being driven by algorithms and predictive analytics.

Fortunately, solutions to address the nuances of digital peer support have been developed. One of the most beneficial is training in digital peer support. Magellan partnered with Dr. Karen Fortuna to provide specialized training to our team members who provide peer and family support. Many other organizations and agencies have completed this training as well. It’s an important and necessary step to take as we navigate this new normal.

If you want to learn more about the state of practice relevant to digitally delivered peer support, check out this article from the April 2020 Journal of Medical Internet Research by Dr. Fortuna, Digital Peer Support Mental Health Interventions for People With a Lived Experience of a Serious Mental Illness: Systematic Review.

As we learn more about what works and what could be improved with peer support services via telehealth, we are paving new ground. What we do over the coming weeks and months will set the trajectory for digitally delivered peer support.  Let’s make sure we get to where we want to go safely, respectfully and responsibly.

This is an excerpt from the full eMpowered for Wellness May newsletter. To read the full article, go here.

Anyone who has gone through a traumatic event can develop symptoms of stress disorders such as post-traumatic stress disorder (PTSD).  Although the COVID-19 pandemic in general would not meet the criteria for formally causing a stress disorder, many of the same issues can result from such a widespread and overwhelming event.

The pandemic could be viewed as a long-term stress event.  It has become life-changing for the whole world.  As COVID-19 spreads across the globe, people may experience increased anxiety and fear triggered by the pandemic and constant news. In addition, the pandemic can be traumatizing for others: healthcare workers, people who have lost friends and loved ones, and people whose lives have drastically changed.

What are stress-related disorders?

Stress-related disorders can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening. These symptoms can change your behavior and how you live your life.

How can reaction to the COVID pandemic be similar to a stress disorder?

When you struggle with a stress disorder, it can be hard to anticipate when anxiety or depressive symptoms may flare up. Although it may appear that symptoms come out of nowhere, in most cases they are cued by factors called triggers. Internal triggers are the feelings, thoughts, memories, emotions, and bodily sensations that you feel or experience. External triggers are the people, places, and situations that can bring back memories of the traumatic event.  In the current environment this could be caused by news reports, social media or discussion with friends or family.

The first thing to realize is that many fears are unwarranted; anxiety may arise when you are in a completely safe environment. When you begin to despair or your fears consumer you, try to remember that your worries and fears may be extreme because of previous experiences and not current facts. Once you’ve realized what may trigger these fears and anxiety, you can begin to try to deal with them.

How to cope with stress-related symptoms amid COVID-19

• Cultivate ways to be calmer. It’s understandable to feel anxious and worried about what may happen. While circumstances may be stressful and beyond your control, you can try to offset them with positive, calming activities. Practice slow, steady breathing and muscle relaxation, as well as any other actions that are calming for you (yoga, exercise, music, keeping the mind occupied).
• Understand what is within your control. Accept circumstances that cannot be changed and focus on what you can do. Evaluate your risk of contracting the virus, practice social distancing and follow clinical guidance on other practices. If you are in quarantine or isolation, do things that can support your mental health.¹ Focusing on what you can control and do can help you deal with the unknown.
• Remain hopeful. Keep a long-term perspective. Look for opportunities to practice being more patient or kind with yourself, or to see the situation as an opportunity to learn or build strengths. Celebrate successes, find things to be grateful about, and take satisfaction in completing tasks, even small ones. Remember that this will not last forever.
• Lean on your network. Make the most of technology and stay in touch with colleagues, friends and family via phone calls, texts, social media and video conferencing. Consider joining a free support group online to stay connected.² If you have a therapist, try to continue your treatment by phone or online.
• Focus on the potential positives. Try and focus on the things that can be viewed positively such as spending more time with family and a experiencing a potential to grow. Many times, going through a stressful time like this can lead to post-traumatic growth. This growth can be seen as though the stressful event was a trial or challenge that you conquered, something you learned from and became more resilient through. Sometimes stress can stimulate personal growth and improved overall coping.

For more information and tips, www.MagellanHealthcare.com/COVID-19.

Edith Calamia, DO, MPH, CMD, was a teenager when she saw the impact that lack of access to clean water, food insecurities, and unreliable access to care could have on vulnerable populations.

As a young woman Dr. Calamia traveled to the Philippines during summer vacations. There, she would assist her brother, a dentist, in small dental clinics in towns outside Manila. In the Philippines, where eight out of 10 people face dental health issues, millions of people have never seen a dentist due to absence of transportation and limited education. Without proper care, dental decay can lead to chronic disease, premature births, low birth weight, and more.

“As a young person growing up in the ‘70s, I remember thinking that sections of extreme poverty like those I had seen in the Philippines and also in Africa would no longer exist by the time I was in my 30s or 40s,” she says. “I thought we would solve those issues. Now, as the mother of a small child, I’m very passionate about addressing social determinants of health in the United States and abroad so that our children don’t have to find solutions to these problems in their 30s and 40s.”

Dr. Calamia, who joined Magellan Complete Care as chief medical officer in December 2019, sat down to discuss the role of healthcare organizations in addressing social determinants of health (SDOH)—the conditions in which people live, learn, work, and play that can affect health risks and outcomes—and ways that organizations can strengthen their approach.

Magellan: Could you tell us what sparked your passion for caring for vulnerable populations?

Dr. Calamia: My dad was a pilot for Pan American, and from an early age, my three siblings and I traveled internationally, including to Africa, the Philippines, and other countries. We became very cognizant of the impact that social determinants of health—from socio-economic factors to an individual’s physical environment—have on vulnerable populations, from the ability to access basic healthcare services to the ways in which barriers to basic necessities affect health and health outcomes. These experiences prompted each of my siblings and I to enter the medical field.

Early in my healthcare career I did work in Miami and was inspired to go into public health. I completed a fellowship in geriatrics, which enabled me to go into the homes of the seniors I was treating, which underscored for me the difference in health and health outcomes that can be achieved when individuals have reliable access to basic necessities as well as skilled care.

Magellan: What are some of the lessons you learned early in your career about ways to leverage federally funded programs to improve outcomes for the most vulnerable populations?

Dr. Calamia: When I was in private practice, my organization treated people who were on Medicare and Medicaid as well as those who were uninsured, but it was very difficult to support the care of these populations, financially. So, I got together with a group of providers on Staten Island [New York] to open a federally qualified health center (FQHC). This was a journey: It required us to form a community board to guide us through this process. I served as chief medical officer for the FQHC, and I worked with people who had been in the FQHC space for years and years. Through this experience, I learned how to be a good fiscal steward of the federal dollars we received by thinking about our programs strategically, with an eye toward which initiatives would make the biggest difference in members’ health. We concentrated on providing services for the most vulnerable mothers and infants in our community—for example, mothers who smoked or showed signs of substance use disorder; babies with low birth weights or whose first days or weeks were spent in the NICU. We were able to start the FQHC, and open two more centers. I’m really proud of that work.

Later, I joined a managed care company (MCO) and began to view social determinants of health initiatives from that organization’s point of view—which in some instances is a steward of both state and federal dollars.  Here, I began to look at the types of relationships that were necessary to ensure value. For example, how do MCOs find centers of excellence—the organizations that really move the needle on quality and value—to send their members? How do they make sure the programs these organizations provide meet the needs of their members and improve health outcomes?

As a result, we developed a partnership with Camden Coalition to determine how a very intense care management model could keep members out of the emergency department and keep them healthy. At that time, the managed care space incorporated more of a disease management model that wasn’t a face-to-face, in-home visit, hands-on model of care. After running a pilot program, we partnered with Camden Coalition to develop, test, and scale new models of care for members with complex health, behavioral, and social needs.

Magellan: What are some of the biggest challenges healthcare organizations face in addressing social determinants of health?

Dr. Calamia: I think we’ve been challenged as organizations to really measure the effectiveness of our interventions around the social determinants of health. We know that addressing social determinants of health is the right thing to do, and anecdotally, we have many stories about the ways in which addressing social determinants of health can change individual members’ lives. We need to aggregate, on a national level, the data we have and dig deep into the information we can glean from that—exploring where we can build relationships on a local level to change a few lives at a time and then using the lessons learned to scale our approach on a national level for specific populations.

Gaining access to this data may be a challenge for providers’ organizations as well because of limited resources and bandwidth. That’s why it’s so important that MCOs lean in and help them with the data piece—aggregating the data and providing the insight that can help providers dig deeper at the point of care.

When we think about social determinants of health, we have to look at the long game when it comes to understanding the results of our efforts. It’s also critical that we examine the potential for technology and digital apps, in combination with personalized care management, to help meet the needs of our most vulnerable populations in a holistic way. In doing so, we can more effectively help members live healthy, vibrant lives.

Magellan: How are SDOH coming into play during the COVID-19 pandemic?

Dr. Calamia: In so many ways. People are stuck in their homes. If they live in a crowded apartment building, it’s hard for them to distance themselves from others. Home may not be a safe place for victims of domestic violence. In certain urban areas, it’s already hard to get fresh food; with the pandemic limiting distribution, people are eating more processed foods. People who rely on home care services and home-delivered meals aren’t getting the services and sustenance they need. We’re seeing problems with meal distribution and have ordered restaurant take-out meals to ensure our members are fed. The health conditions many people have as a result of SDOH make them more likely to get very sick from the virus. That’s why it’s becoming more important than ever to address these issues.

 Magellan: What attracted you to Magellan?

Dr. Calamia: One of the biggest barriers I’ve seen in my career is helping patients and members determine where they are in their health journey and understanding their mental health needs. Magellan has a rich history of understanding mental health as a key social determinant of health. Frankly, the behavioral health community really understands social determinants of health. They have explored issues such as: Where do members live? Do they have food insecurities? Have they experienced childhood trauma that makes them more comfortable receiving care in an emergency department versus an office? Things of that nature. I believe there’s a chance to create something at Magellan that is really unique, leveraging Magellan’s behavioral health and pharmacy expertise as well as its depth of experience in working with MCOs to make a deep impact on social determinants of health.

We’re going to change the way in which people can access their healthcare, and we’re going to change the way that people feel about their MCO as a partner.

Edith Calamia, D.O., M.P.H., C.M.D., is national chief medical officer for Magellan Complete Care (MCC). Dr. Calamia joined Magellan in March 2020 and oversees all clinical programs within MCC. She also leads the development and delivery of health plan-specific clinical programs targeted to complex populations such as those needing Long-Term Services and Supports, those who are dually eligible for Medicaid and Medicare, people with Serious Mental Illness, and recipients of Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP) benefits.

While the pandemic may be causing you and your loved one feelings of anxiety and apprehension, now is a good time to look for reasons to be happy. Practice these tips to nurture yourself, improve your mood and help others.

1. Be kind. Call your friends and neighbors. Maintain social distancing, but smile to all the grocery workers who are keeping the shelves stocked. Ask an elderly neighbor if they need anything. An act of kindness boosts serotonin, a natural antidepressant in your brain, in both you and others.

2. Be thankful. Don’t rush through your daily interactions on autopilot. Slow down and notice when someone is kind to you, even in the smallest way, and show them your appreciation. When you practice thankfulness, you become more positive; that helps others feel good too.

3. Deepen your connections: Share your feelings about this experience with those closest to you. Encourage each other to make the best of this moment in time, and come up with a game plan to support each other moving forward.

4. Move your body. Exercise is vital to maintaining physical and mental health. Get your heart pumping by taking a walk in your neighborhood, going on a hike in nature or using an app for a guided training or yoga session. If you do go outside for a walk, maintain social distancing.

5. Write down your thoughts. Keeping a journal is a powerful way to get perspective. Clarifying your thoughts and feelings on paper helps you get to know yourself better and release the stresses of daily life.

6. Meditate. All you need to do is sit quietly for a few minutes, breathe deeply and let your mind relax. Meditation alleviates anxiety and helps you get in touch with your inner self, helping you face the world in a centered and focused way. Find free guided meditation sessions online.

7. Determine what is really bothering you. Vague worries are harder to manage because they are all jumbled together. Try to get clear on what you are specifically concerned about. Finding the root of the worry helps you figure out what to do about it.

8. Play games. Engaging in a game with others online, or even by yourself on your phone, helps you take your mind off other things. Give yourself permission to have some fun.

9. Dine Well. Have fun with food. Make your favorite recipes. Set the table with your finest dishes. Cook a meal with others. If you live alone, share pictures with friends for fun.

10. Remind yourself that this will pass. Try and come to terms with what you can’t control, and focus on what you can do to move through this time in a positive way. Draw on skills you have used during other difficult times, and remember how those times eventually passed by.

For more information and tips, visit MagellanHealthcare.com/COVID-19.