In 2019, Time magazine listed virtual reality (VR) as one of the 12 innovations that will change health care and medicine in the 2020s. With this projection, the probability that you will use VR sometime in your life is high! VR is currently being used in a variety of fields, including

• Mental health
• Pain management
• Rehabilitation
• Training and education

VR is not a fad, as studies are underway for its potential efficacy to treat Alzheimer’s disease, depression, addiction, and other illnesses. This new field of medicine collectively referred to as medical extended reality (MXR), encompasses VR and augmented reality (AR). There are many aspects in the VR landscape including safety, regulations, and value to name a few. Let’s dive in and explore some of the clinical uses of this emerging trend.

Pediatric Intervention
Children are often under-treated and under-recognized when it comes to managing pain, fear, and anxiety. Thus, VR is utilized in children’s hospitals, such as Stanford Children’s Health, to engage and distract children during painful procedures. At the Lucile Packard Children’s Hospital Stanford, VR is used in several ways to reduce pain and stress, including the use of AR goggles for patients in the pre-op so they can watch movies and play games prior to surgery, and the use of VR games in the intensive care unit (ICU).

Mental Health Treatment
With an estimated 52.9 million adults suffering from mental illness in 2020 according to the Substance Abuse and Mental Health Services Administration (SAMHSA), one of the biggest challenges today is the rising demand for mental health treatment and a shortage of available providers. As another tool to tackle mental health conditions, VR now contributes to the availability of additional resources.

The use of VR software simulates real-world settings that closely resemble the surroundings of daily life so that triggering stimuli such as anxiety, paranoia, fear, and cravings can be assessed and treated. Anxiety disorders are already being treated using virtual reality exposure therapy (VRET) as a potentially scalable tool. In addition to anxiety-like disorders, VR is being studied for several other disorders.

There is evidence that VRET reduces post-traumatic stress disorder (PTSD) symptoms, with sustained improvements at six and twelve months after treatment. Among children with autism spectrum disorder (ASD), a recent research initiative demonstrated that VR combined with cognitive behavioral therapy (CBT) improved specific phobias. For seniors who suffer from social isolation, Rendever has developed a VR platform designed to reduce depression and loneliness.

Chronic Pain Treatment
A Centers for Disease Control and Prevention (CDC) survey in 2019 found that 20.4% of US adults have experienced chronic pain. Persistent pain is linked to depression and anxiety and can become an overlapping symptom.

In a study conducted by Cedars Sinai, VR reduced hospitalized patients’ pain scores by 24% and was most effective for patients with severe pain. In November 2021, a prescription medical device (RelieVRx) was authorized by the US Food and Drug Administration (FDA) as the first at-home VR therapeutic as an adjunct to treat chronic lower back pain.

Virtual Rehabilitation
While the benefits of physical therapy have long been established, some patients who would benefit from PT do not have access to it. In recent years, VR rehabilitation has been gaining traction with a host of conditions from chronic pain, stroke, and Parkinson’s disease to multiple sclerosis, dementia, and cerebral palsy. VR-assisted rehab may offer advantages for patients such as improved patient engagement and motivation, poststroke functional recovery, and improved mobility in Parkinson’s patients.

Training and Education
It can be challenging for educators to meet learning objectives through standardized medical training, especially as healthcare systems evolve. VR training and education, allow personnel, students, and residents to learn in a controlled environment while minimizing risks to real patients. As a result, VR systems are increasingly used in hospitals to train residents, assist surgeons with surgical planning, and educate patients. In a UCLA study, participants using the Osso VR platform significantly improved their overall surgical performance compared to conventional training methods.

Health Inequities
The healthcare system continues to be affected by structural racism, affecting the well-being of all people, especially those who have historically been marginalized. The use of VR as a training tool is currently being explored for a better understanding of the cultural needs of patients, with the possibility of VR becoming a tool for increasing empathy and giving people a broader perspective when interacting with individuals of different racial and economic backgrounds.

With VR technology developing at record speed and its potential to transform healthcare, we are keeping VR on our radar. We encourage you to learn more about VR and the world of MXR by visiting our website to explore our latest white paper: Virtual Reality – An Emerging Paradigm in Healthcare

This is just the beginning!

Patient management programs are important for both payers and patients. Successful patient management programs can improve health outcomes and quality, increase member enrollment, and improve member satisfaction, all of which support the health plan. The goal of a successful patient program is to improve the quality of medication use and the overall health and wellness of the patient, and this can be achieved through patient engagement and empowerment.

Knowing all of this, the challenge for a patient management program is often getting patients to participate. Traditionally, this has occurred through live and/or automated telephone calls and mailed letters to the patient, and additional faxes to the patients’ providers. These approaches have varied engagement results, and there are growing concerns that there is a ceiling to how many patients can be engaged through these modalities.

Adults are working longer into life than ever before, making them harder to reach and talk to during traditional business hours. In addition, letter campaigns become more and more costly as postage rates continue to rise, and a growing interest in “going green” makes mass mailings appear wasteful.

Newer technologies and the prevalence of mobile devices present new opportunities to engage patients, particularly the millennial generation that are now becoming patients themselves.

Today’s patient likely has a smart phone and may also have a tablet and/or wearable device, all of which provide a means to communicate with his/her provider(s). With that in mind, here are several ways that patient management programs can evolve using technological advances:

Text Messaging – Text messages have become the go-to method of communication for many people. Responses can typically be received in a matter or minutes, and even “busy” patients can text when a phone conversation may be a non-starter. Beyond one-way alerts and reminders to the patient, two-way exchanges and even live chat features are available.

Video Conferencing – For patients who may be not wish to text, online video capabilities allow for face-to-face counseling between clinicians and patients, even if that consultation isn’t in a conventional setting. As opposed to telephone calls, video chats allow for perception of non-verbal cues, assessment of physical symptoms, and even walkthrough tutorials, like injection training.

Artificial Intelligence (AI) – AI can range from predictive modeling and analysis used to predict potential adherence issues, to apps that can monitor, track, and measure adherence through features like facial recognition, digital pills, and more.

Video on Demand – Consumption of video content via mobile devices is as common as ever, and there are services available which can provide patients with additional drug information that can accessed whenever, wherever. These videos can reinforce talking points covered during consultation and provide a compliment to education provided through patient management programs. It also allows for information to be shared in a paperless way.

Privacy is a funny thing, and peoples’ choices about privacy when technology is involved is often hard to explain. We don’t think twice about letting companies track what we like and don’t; what we search for and when we search; the photos we like and the ones we don’t; our shopping patterns and our wish lists; where we go and when; and now, we welcome full-time listening devices into our homes. I often wonder if these listening devices would find their way into our kitchens if they looked more like a reel-to-reel recording device versus a cute little modern orb with fancy LEDs.

Despite how comfortable we are with technology in some parts of our lives, there seems to be a line that many won’t cross. For some reason, discussing our finances while the orb is listening is okay, but using technology to help us manage our healthcare strikes some people as going too far.

This line is moving, albeit slowly.

There are real challenges in advancing technology in healthcare. But most importantly, we need to allow consumers to choose how they want to see their health information.

Texting is common in healthcare today, but it is inefficient, and often, confusing. Most healthcare-related texts contain either redacted information, such as, “You have not filled AtorXXXXXXXX prescription,” or contain links on which you have to click to take you to another message. Amazon doesn’t make a customer guess at the contents of their message or follow a clunky process to share information, so why do we do it in healthcare?

There are a number of regulations that govern Protected Health Information (PHI), and it’s critical that we take them seriously. After all, we’re talking about very sensitive and private material about diagnoses, medication, diagnostics and other information.

But, with careful planning and execution we can balance what is required of us by law while providing consumers with information that will help make their healthcare journey more efficient and tech-enabled. For example, we were able to craft, on behalf of our clients, end-user agreements that allow us to send texts that look like this:

“Your health is important to [Insert Client Name], please take your cholesterol medication as prescribed.”

The results from this texting pilot were nothing short of amazing. 26 percent of the people who received this message, none of whom were previously following their doctor’s orders, promptly filled the prescription. Interestingly, we saw similar results in every category we piloted. Why? It’s simple: nothing had to be decoded, no incremental steps needed to be taken, no password had to reset, etc. The best part of the pilot? 87 percent of the people who started, stayed in the program.

With pilots like this, we moved the line a smidge.

Texting was one of our first pilots and it was critical to challenging our thinking and finding new ways to solve old problems. The line needs to keep moving forward and we welcome the challenge.

Trouble sleeping? You are not alone. Sleep problems and insomnia affect nearly 40 percent of Americans each year. Not only is insomnia very common, it is also associated with increased risk of stroke,^[1] diabetes,^[2] obesity,^[3] alcohol misuse,^[4] depression^[5] and anxiety.^[6]  When individuals have insomnia and another one of these conditions, it can be particularly problematic. Cognitive behavioral therapy (CBT) is widely recognized as the gold standard for long-term management of insomnia.^{[7],[8],[9],[10]} However, CBT can be difficult to access and is relatively inaccessible for individuals with limited economic security.

Through increasing access to quality, well-studied CBT programs, Magellan seeks to reduce the overall cost-of-care and improve individual health outcomes. Team members at Magellan recently collaborated with academic researchers on a project to make Magellan’s computerized CBT programs, referred to as Cobalt, accessible to patients with insomnia in a community health setting. Participants included individuals who lived in shelters and community homes, as well as individuals with serious mental illness.

Participants received access to RESTORE^TM, one of several data-driven programs in the Cobalt suite, which has been shown to be effective in randomized controlled trials. RESTORE^TM has also won praise from the American Academy of Sleep Medicine ^[11] and received the highest rating from the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices. The research findings, published in the Journal of Clinical Sleep Medicine, demonstrated significant improvements in sleep quality. This suggests that implementing RESTORE^TM in a community mental health center setting may make accessing effective tools for improving sleep a straightforward process.[12]

Magellan continues to lead in the healthcare field through collaborations like this one, where academic partners are collecting real-world data that demonstrate how its industry leading Cobalt programs can help increase access, lower costs, and improve individual health outcomes. We are excited by the power of technology to improve care and access to care for individuals regardless of their economic status, as we work to lead humanity to healthy, vibrant lives.

[1] Elwood, P., Hack, M., Pickering, J., Hughes, J., & Gallacher, J. (2006). Sleep disturbance, stroke, and heart disease events: evidence from Caerphilly cohort. Journal of Epidemiology Community Health 0:69-73.

[2] Cappuccio, F., D’Elia L., Strazzullo P., & Miller, M.A. (2010). Quantity and quality of sleep and incidence of type 2 diabetes. Diabetes Care; 33:414-20.

[3] Gangwisch, J., Malaspina, D., Boden-Albala, B., & Heymsfield, S.B. (2005). Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep; 28:1289-96.

[4] Crum, R.M., Storr, C.L., Chan, Y-F., Ford, D.E. (2004). Sleep disturbance and risk for alcohol-related problems. American Journal of Psychiatry;61:1197-203.

[5] Riemann, D., Voderholzer, U. (2003). Primary insomnia: a risk factor to develop depression? Journal of Affect Disorder; 76:255-9.

[6] Breslau, N., Roth, T., Rosenthal, L., Andreski, P. (1996). Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.  Biological Psychiatry;39:411-8.

[7] Schatzberg, A. F., & Nemeroff, C. B. (2009). The American Psychiatric Publishing textbook of psychopharmacology. Washington, D.C: American Psychiatric Pub.

[8] American Psychological Association. (2004). Getting a Good Night’s Sleep with the Help of Psychology.

[9] American Academy of Sleep Medicine (2013). Evaluation and Management of Chronic Insomnia in Adults.

[10] Agency for Healthcare Research and Quality. (2013). Clinical practice guidelines for the management of patients with insomnia in primary care.

[11] American Academy of Sleep Medicine. (2009). Online Cognitive Behavioral Therapy is Effective in Treating Chronic Insomnia.

[12] Feuerstein, S.D., Hodges, S. Keenaghan, B.C., Bessette, A., Forselius, E., & Morgan, P.T. (2016). Computerized Cognitive Behavioral Therapy for Insomnia in a Community Health Setting. Journal of Clinical Sleep Medicine.