The following is an excerpt from the 2018 Magellan Community Impact Report.

It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

No one is exempt from experiencing the effects of the opioid crisis. Magellan’s own Janet Edwards, RN, senior clinical director of Magellan’s Chronic Pain Management program, describes how close to home the opioid epidemic hit her:
It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

“My daughter, Nikki, was 26 when she  died of a Fentanyl overdose. As the mother of a six-year-old and a critical care nurse working in a respected healthcare organization, Nikki was the picture of success. But to handle the pressures of nursing school, a full-time job, and life as a single mother, Nikki sought prescriptions for Adderall and Xanax from multiple physicians. Over time, her addiction to these substances gave way to a new addiction: Fentanyl, which she began to confiscate from the critical care unit where she worked.
Like many others, Nikki didn’t show any signs of addiction. But five years after her son was born, Nikki sat at my kitchen table and admitted that she was addicted to heroin. She was afraid to get help, because she did not want to lose her job or the respect of her peers. She insisted she could recover on her own. Even though I, as a nurse, knew the odds were not good that Nikki could manage her recovery alone, I respected my daughter’s wishes. It’s a decision I will forever regret. Eleven months later, Nikki died of an accidental overdose in front of her son and a friend.”

Following the loss of her daughter, Janet has openly shared Nikki’s story, becoming an advocate for helping prevent opioid addiction. Further, Janet has taken on clinical leadership of Magellan’s Chronic Pain program, which offers alternatives to opioid use.

Meeting opioid users where they are

No matter where or how someone encounters opioids or where they may be in the cycle of use, dependence or addiction, Magellan offers many other ways to address the opioid problem. Our behavioral health products forged from decades of serving the public, our specialty healthcare solutions supported by clinical excellence, and our customized pharmacy programs are ready to answer the call as organizations and individuals look for answers.
Hosting a forum for sharing successes  and discussing solutions

In September 2018, Magellan brought together  national and local leaders in Pennsylvania to  exchange ideas, share successes and  discuss solutions to the opioid  epidemic in our communities.  The free, second-annual  conference featured  keynote addresses and  workshops and highlighted  the proactive efforts of local  organizations. Participants included  national and state officials, county human  services and drug and alcohol leaders, legislative  staff, providers and community stakeholders.

Not staying silent on the silent epidemic

Magellan is actively helping individuals and families on their path to recovery. Further, to educate the public, doctors and other healthcare providers, we offer resources on our Magellan Health OPIOID INSIGHTS microsite. The site includes links to blog posts, videos, resources and published articles.

Hosting a forum for sharing successes and discussing solutions

InSeptember2018, Magellan brought together national and local leaders in Pennsylvania to exchange ideas, share successes and discuss solutions around the challenge we face together in addressing the opioid epidemic in our communities. The second-annual conference featured keynote addresses and workshops and highlighted the proactive efforts of local organizations. Participants at the free one-and-a-half-day conference included national and state officials, county human services and drug and alcohol leaders, legislative staff, providers and community stakeholders.

Primary care providers can be responsible for everything from first line dermatology to behavioral health to musculoskeletal injuries. In a world of rapidly changing technologies, and in which new therapies can cure or alter diseases that only a few years ago would have never been thought possible, the basics still matter. As a clinician, I’ve practiced internal medicine and psychiatry, and still have the opportunity to work with a FQHC in building integrated care. Those experiences and my national view of utilization and prescribing patterns highlight the need for provider support to care for persons with mental health conditions, including opioid use and abuse.

It is often challenging to translate new medical knowledge to the clinic setting. How does a provider care for the individual on a potentially lethal combination of opioids, benzodiazepines, and muscle relaxants? Or, how does one address the young child who has been placed on a combination of psychotropic medications.

In our current health system, primary care providers are in the best place to begin patient care journey or change the course of an already established treatment plan. An effective solution for supporting providers in delivering high quality care is in the form of provider support, especially through programs that involve data analytics, followed by one on one academic detailing. PBMs are in a unique position, having the ability to assist providers in working with patients on complex behavioral health or opioid regimens. PBMs have access to data that allows for identifying outlier member and provider behavior and finding patients who are at risk for adverse outcomes. While PBMs don’t have access to prescription drug monitoring programs, they can see what prescriptions are filled, where there is overlap, and where there are multiple providers interacting with a patient.

Magellan Rx developed the Live Vibrantly: Whole Health program to address those outlier providers and members, with the goal of achieving higher quality care. This program uses evidence-based algorithms to find members who may be at risk for adverse outcomes, and targets prescribers who may be over-prescribing. We become the provider’s go-to source for translating the evidence to the bedside through assistance with difficult issues, such as withdrawing an individual from high dose opioids. Through taking an approach to support providers in delivering high quality care, we’ve been able to truly partner in leading our members to leading more healthy vibrant lives.

With the number of opioid-related overdose deaths in the U.S. reaching a record high last year, it’s time for our nation to fully embrace evidence-based treatment options that best support our communities, loved ones, friends and families in their recovery efforts.

One growing approach—often considered as the gold standard of treatment—is medication-assisted treatment (MAT). MAT is the use of FDA-approved medications in combination with counseling and behavioral therapies to provide a holistic, person-centered approach to the treatment of substance use disorders (SUDs). The use of this treatment approach has grown to nearly 40 percent in residential facilities and is increasingly leveraged by primary care providers nationwide—but more still must be done for widespread adoption.

The most pervasive stigma surrounding MAT is that it merely enables patients to replace one addiction with another. It’s a belief held not only by some groups of doctors and clinicians, but also family members and peer support groups—those whose support is critical to successful recovery. When a patient’s core support system of family members and peers doubts the legitimacy of an evidence-based form of treatment, the likelihood that the patient will follow through long-term is diminished.

Pair that with a lack of understanding and comfort from the medical community around how to administer MAT, limited numbers of physicians who are certified to prescribe this treatment that actually do prescribe the treatment, as well as the number of residential facilities that offer MAT, and we get low adoption rates as a result of these barriers.

There’s a better way to treat opioid use disorder

Although abstinence-based therapy works for a small percentage of those suffering from OUD, MAT offers a successful way for people to fight their addictions in an outpatient environment, in the community in which they live, and avoid hospitalization or institutionalization. It helps those struggling with OUD and other SUDs address underlying conditions that may have contributed to substance abuse—significantly improving the chances of recovery. In one study, more than half of patients utilizing MAT reported opioid abstinence 18 months after beginning treatment.

Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction. And even fewer actually prescribe buprenorphine to patients. MAT prescribing is not limited to psychiatrists. In fact, primary care providers provide more access to MAT than any other type of provider.

The impact of limited access to MAT on health outcomes cannot be overlooked. One analysis found only one-third of individuals who experienced a nonfatal opioid overdose received access to MAT. Those who received methadone were linked to a 59 percent decrease in mortality rates after one year, according to the analysis. Additionally, individuals who were treated with buprenorphine were associated with a 38 percent decrease in mortality after a year.

Increasing Access to MAT

The SUPPORT for Patients and Communities Act, signed in October 2018, expands the ability to prescribe MAT by increasing clinician eligibility for certification. This provision is a solid and necessary step toward broadening access to treatment; however to make a true impact on the opioid epidemic, we must break the stigma surrounding MAT.

When it comes to recovery, the potential for relapse is high, especially in the early stages when resolve is fragile. It is important to note that for individuals with co-occurring mental health conditions, chronic pain or other addictions, MAT should be supplemented by treatment for those conditions, such as cognitive behavioral therapy. Building in care management support to assist in navigating the treatment process may reduce the possibility of relapse and/or readmission to a substance abuse inpatient or residential rehabilitation program. It also helps provide individuals with the tools needed to live addiction-free.

By taking the time to dispel the myths about non-traditional addiction treatment like MAT, we create an environment that more fully supports a return to complete health—physical, mental and emotional. Fighting the stigmas around MAT is an important step toward enabling those suffering from OUD to recover from their addiction and live healthy, vibrant lives.

By Sam Srivastava and Mostafa Kamal

This week, the federal government took a significant step forward in helping address the opioid epidemic with the signing of the nation’s first comprehensive opioid legislation.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act addresses a broad range of Medicare, Medicaid, public health and law -enforcement issues and aims to advance the recovery landscape for individuals living with opioid use disorder (OUD) and other substance use disorders (SUDs).

As longstanding advocates for access to mental health and substance use disorder treatment and services, we’re deeply appreciative of the bicameral, bipartisan work of the Congress to successfully drive this critical effort forward. The legislation contains a number of impactful policies we at Magellan Health, and many others, have pushed for, including those recommended in our testimony to Congress this past spring. These critical policies promote clinically appropriate opioid prescribing, support opioid misuse prevention, and enhance access to evidence-based treatment and recovery services.

The signing of this law marks a significant milestone and step in the right direction, and we believe there are several ways it has the potential to address some of the day-to-day challenges of the nation’s opioid epidemic. Three key areas stand out.

Safer prescribing patterns. The SUPPORT for Patients and Communities Act encourages the use of safe and effective alternatives to opioids for pain management, which – in addition to clinically appropriate prescribing practices – are key in breaking the cycle of prescription opioid misuse. These include the establishment of grant programs incentivizing the use of non-pharmacological opioid alternatives, the required implementation of safety limits for opioid prescriptions, new electronic prescribing requirements in Medicare, and beneficiary screening requirements in initial Medicare prevention exams, to name a few.

Our experience demonstrates the power of these and other safe-prescribing interventions—such as the Centers for Disease Control and Prevention’s prescribing guidelines, which Magellan has already implemented—to reduce opioid misuse rates.

Americans consume 80 percent of all opioid painkillers produced worldwide—and the risk of addiction after just four or five days of treatment is high. Opioid prescribing rates have decreased in recent years thanks to nationwide efforts to ramp up provider education. Yet the supply of prescription opioids remains high – approximately 66.5 opioid prescriptions for every 100 Americans in 2016 – reflecting the work still needing to be done.

By exploring alternative therapies to pain management, including non-pharmacological digital therapies, we can eliminate the risk of opioid misuse and addiction, and also equip individuals living with chronic pain with the tools and resources needed to live healthier, more vibrant lives.

Boosted access to evidence-based treatment. One of the most effective, evidence-based treatments for OUD is medication-assisted treatment (MAT)—considered the gold standard for reducing the risk of overdose and death. When combined with psychosocial interventions, like cognitive behavioral therapy and contingency management, and recovery supports, including peer and family, MAT empowers the recovery journey while building resiliency.

Increasing access to MAT is critical to promoting recovery and preventing relapse. Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction.  Even fewer of these actually participate in prescribing MAT and, as a result, access to care is often limited or stigmatized. The SUPPORT for Patients and Communities Act expands providers’ ability to prescribe MAT, including by expanding eligibility for certification to new provider types. With stigma also playing a role in the lack of widespread adoption of MAT, this provision is a solid and necessary step toward expanding access to treatment.

Reaching underserved communities. The SUPPORT for Patients and Communities Act facilitates telehealth options for OUD treatment. In communities with limited resources for one-on-one OUD recovery support, telehealth services or a combination of virtual and in-office services provide the basis for the most evidence-based, person-centered and well-rounded approach to treatment. The package also authorizes pilot programs to provide temporary housing services for individuals recovering from OUD. We believe this is crucial to supporting those living with OUD and other SUDs, especially in rural and underserved communities, return to healthy and vibrant lives.

 The SUPPORT for Patients and Communities Act provides practical policy solutions necessary for addressing this national crisis. From expanded treatment options, to more effective care coordination, to improved prescription drug monitoring programs used to enhance detection and prevention of opioid misuse in real time, this legislation is an important step in the right direction.

We applaud Congress and the Administration on this bipartisan effort and important law, which will have a deep and lasting impact on health for generations to come.

 About the authors:

Sam Srivastava is Chief Executive Officer of Magellan Healthcare, and Mostafa Kamal is Chief Executive Officer of Magellan Rx Management.

“Strung out. Looking for the next fix. A full time job that doesn’t pay, but just takes.”

That’s how one of Magellan’s Recovery Support Navigators defined her addiction to opiates. She has since overcome the stranglehold of addiction and is now in long term recovery.  Her experiences, and those of her fellow Recovery Support Navigators, provide the credibility needed to influence their peers who are still struggling with addiction and mental illness that recovery is possible and that desperation does not have to define a life.

An estimated 20.2 million Americans live with a substance use disorder[1]. That’s the population of my home state of Florida. Of that, 2.1 million Americans live with an opioid disorder. Similar to serious mental illnesses, substance use disorders can be difficult to address. Those with the lived experience of walking the path from hopelessness to wellness are experts at engaging individuals with the services and supports that foster the recovery process. Stories of changed lives are not the only proof.

A January 2018 study of our internal recovery support navigation program at Magellan Health found statistically significant improvements for individuals living with substance use and mental health disorders. A key component of the Magellan’s internal peer support program is meeting people where they are. The first engagement with members often happens in an emergency room, inpatient setting, or on the streets. Members then choose where future meet-ups happen. Often, that choice is in the comfort of their own home.  If they are experiencing homelessness, the member chooses a safe place.

The study compared utilization of services six months prior to receiving peer support services and six months following the completion of peer support services. Seventy-five percent of the members in the study had a co-occurring mental health and substance use disorder and 50 percent had a co-occurring substance use disorder, mood disorder and psychotic disorder. The study found that members in Magellan’s internal peer support program cost the health plan significantly less in the six months following completion of the peer support program than members who only had care management or who did not receive any intervention from the health plan. The study also found that six months after completing peer services, peer support decreased emergency room and inpatient hospitalizations.

The role modeling by a peer specialist of a life lived well in recovery is evidence for the individual struggling that there can be long term sustainment of recovery. In addition, the data from this study replicates prior findings that peer support has a lasting impact on the lives of those living with substance use and mental health disorders.

[1] Substance Abuse and Mental Health Services Administration. (2017). Mental and substance use disorders. Retrieved from https://www.samhsa.gov/disorders

Magellan Health today announced the launch of a new thought leadership website, www.MagellanHealthResources.com.

With a curated assortment of materials, focused around individual topics, Magellan Health Resources was designed as a repository of research, information and materials for healthcare professionals, members of the media and researchers.

To launch, Magellan Health Resources is showcasing information and materials around the opioid crisis.

The site includes videos  webinars, downloadable white papers, research, a news archive and more.

You can take a look here

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

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

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

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

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

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

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

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

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

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

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

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