Today, children and adolescents with behavioral health challenges are generally prescribed, and use, an alarming number of psychotropic medications. This excessive usage has raised concerns among families, practitioners and advocates amid questions about the appropriateness of the diagnoses that justify the drugs’ use – as well as the uncertainty surrounding the long-term effects of these drugs on a child’s neurological development.

Thinking ahead about the challenge

Magellan Health has had its eye on this issue for years, publishing a popular monograph, “Appropriate Use of Psychotropic Drugs in Children and Adolescents,” on the topic in 2013, which addressed the anxiety and confusion around the issue. Now – leveraging new data and research – we have released an updated monograph.

We know that appropriate use of psychotropic medications can play a role in helping children and youth with behavioral health conditions successfully live at home, achieve in school and experience positive engagement within their communities. But first parents, caregivers and practitioners need to fully understand the risks and monitor their use. When they’re used in the wrong way, these drugs can lead to a host of medical conditions and social problems that prevent youth and their families from achieving their goals.

10 questions to ask before starting treatment

To tackle this issue in the most practical way, we’ve developed a list of top 10 questions for caregivers, practitioners and the child/youth to discuss before beginning this type of treatment:

The treatment options

1. Are these medications needed?
2. Will the child benefit from therapy?
3. Did the child get a full evaluation from a behavioral health practitioner?

The medication

4. Has the medication been tested and approved for children? What are the risks, benefits and side effects?

The treatment plan

5. How will we know the child is making progress?
6. How often will the child be checked after starting the medications? What happens if we don’t see progress?
7. What warning signs should we look for and when should the doctor be called?
8. Will the treatment be noted in the child’s health care records?
9. Will the practitioner talk to the child’s other health care providers?
10. Does the practitioner know of other medications the child is taking and are there risks in combining them?

Implications

We know practitioners strive to do the right thing for the individuals they serve. With our monograph, we aim to support them in their decision-making process. Our approach is to help primary and behavioral health practitioners – as well as parents, youth and advocacy organizations – make informed decisions that most effectively meet each child’s needs. When the right medications are prescribed and monitored, they can have positive results in a child’s life.

Magellan’s own CTO, Srini Koushik, was recently featured in Forbes Insights, talking about the benefits of videoconferencing and how it is changing the way that we work at Magellan. In the article, Srini discusses how new technology is improving efficiency while increasing connectedness and effectiveness of teams.

Check Srini’s profile here.

Earlier this year, Srini shared his experiences reimagining Magellan as a digital healthcare company here on the Magellan Health Insights blog. Take a look at his views here.

A study by a team of Magellan researchers, demonstrating the pervasiveness of opioid addiction, was featured on CBS Philly (KYW).

The study, an analysis of medical and pharmacy data from 2009—2012 for 2.5 million people aged 20-64 who were part of a commercial health plan, showed that 48 percent of patients who had stopped using opioids for at least six months went on to use them again.

You can read more about the study by clicking here.

As we observe National Suicide Prevention Week 2017, we sat down with Dr. Shareh Ghani, vice president and medical director at Magellan Healthcare who lead Magellan’s Driving Suicide to Zero Initiative.

Magellan Health Insights: Dr. Ghani, thank you for chatting with us today. Tell us about the work you did with the Driving Suicide to Zero Initiative
 Dr. Shareh Ghani: In some parts of the healthcare community, there is a view that suicide is something ‘that just happens’; that it is unavoidable and acceptable. The Driving Suicide to Zero Initiative sought to change that paradigm. Through our efforts in a public health program, we shifted the viewpoint to one that believes that suicide can be stopped and can be driven to zero.

MHI: You have lead a number of initiatives for Magellan, what was your interest in this particular program?

SG: I have been working in mental health since 1993. From 1993 to 1995, during my residency, I had a lot of experience with suicide prevention research, and again working in community psychiatry. There is a lot of good research on the how of suicide, but I want to understand the why.

MHI: You looked at a lot of data as a part of this initiative. Tell us about that.

SG: We were managing the behavioral health contract for Maricopa County between 2007 and 2012. At the time, Phoenix had the seventh highest suicide rate in the country. The suicide rate for those with mental health issues was even higher.

During that time, we reviewed every case of completed suicide to see what could have been done differently.

MHI: What was the Driving Suicide to Zero Initiative hoping to achieve?

SG: Of course, we were looking to significantly impact suicide rates in Maricopa County. But more than that, we were looking to develop a systematized, data-driven, reproducible model.

Part of that meant preparing the clinical workforce to confidently identify at-risk individuals and improve treatment access and engagement. It also meant incorporating family and community participation to better identify early warning signs, navigate the clinical system, and support members at risk.

Finally, there was the integration of a sustainable and replicable clinical and support model and program tools into an EMR [Electronic Medical Record] to ensure that healthcare providers can, from a single source, identify, manage and plan for zero suicides through the safe management of those at risk.

MHI: And what were the results of the initiative? Was it successful?

SG: The results were highly encouraging. Between 2007 and 2012, there was a 67 percent reduction of the suicide rate for the population. Furthermore, there was a 42 percent decrease in the suicide rate of people with serious mental illness.

MHI: You mentioned earlier that the suicide rate was much higher for those with serious mental illness?

SG: Yes, it is a fact that individuals suffering from severe mental illness are six to 12 times more likely to die from suicide than the general population.

MHI: If you could hope that people would take away one thing from the Driving Suicide to Zero Initiative what would it be?

SG: That employing a rigorous, data-driven, scalable and reproducible population health approach to address suicide prevention, and creating a sustainable ecology of support around the individual and the community, is possible.

The Magellan Driving Suicide to Zero Initiative successfully incorporated population surveillance, analytics, research, early detection, intervention and monitoring to shift the paradigm from crisis mitigation to early prevention of suicide.

We’ve all been impacted by the horrific flooding taking place in Texas due to Hurricane Harvey, and witnessed the many instances of heroism and community support in response to this tragedy. In addition to the widespread damage occurring, we have a number of Magellan team members and their families who live in impacted areas and who are witnessing the devastation first-hand. Unfortunately, some are without power, and others have been displaced from their homes.

Leading humanity to healthy, vibrant lives is what we do on a daily basis on behalf of our members, so it’s no surprise that so many of us want to do something to help. I’m proud of what we as a company are doing to support our Texas-based customers, members and affected communities:

• Supporting the Houston Community: The State of Texas, specifically the Houston area, will be living with catastrophic damage for some time and rebuilding from this damage for even longer. The Magellan Cares Foundation is supporting these clean-up efforts with a contribution of $25,000 to the Houston Relief Fund, which is the organization that has been established by the mayor. This contribution will help local efforts to assist those in need.
• Utilizing Our Expertise: When we looked at the forecast for Hurricane Harvey, we opened our 24-hour crisis line early Friday morning for all Texans affected by the storm, whether they are our members or not. Free, confidential counseling services and other resources, such as referrals to local non-profit organizations, shelters and additional community-based support are available to assist Texans as they work to cope with this natural disaster. This line will remain open in the coming weeks and months as the community begins to assess damages and the full impact of the storm.
• Customer/Member Impact: We continue to serve our Texas-based customers, members and others who have been impacted by the storm. Some have likely spent time in shelters, others have lost power, and still others are facing challenges of which we are probably not aware. I’ve asked all of our associates to think about their situation and consider additional ways in which we can best serve them.

No one ever expects to be challenged with a catastrophic event, but I’ve been so proud of the way in which our team has sprung to action to help those in need in Houston.

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.

Magellan Rx Management will soon be hosting the 14^th Annual Specialty Summit.  We had the opportunity to sit down with Phillip Vecchiolli, senior vice president and general manager of our specialty division at Magellan Rx Management to share his thoughts on this exciting event.

Magellan Health Insights: What can attendees expect at this year’s Specialty Summit?

Phillip Vecchiolli: The Magellan Rx Management Specialty Summit has become the source for staying ahead in today’s specialty drug management industry.  We host nationally recognized payers, physicians and industry insiders for a program packed with timely insights, thoughtful debate, and actionable dialogue on emerging trends in the evolving specialty market and effective solutions for managing specialty drug trend.

MHI: When and where is it going to be held this year?

PV: We are excited to be back in the heart of New York City. The event takes place on August 28-30, 2017 at the Sheraton New York Times Square Hotel.  And when attendees aren’t engaging in Summit activities, we encourage them to take in the sights, as we’ll be within walking distance of a number of famous attractions including Central Park, The Plaza Hotel, Radio City Music Hall, MOMA and more.

MHI: Why do you think this event is especially important?

PV: This is an exciting and disruptive time in specialty pharmacy. Specialty drug costs are skyrocketing and without an understanding of the unique dynamics around specialty drug management, payers run the risk of overlooking or misunderstanding this critical area of pharmacy spend.

At Magellan Rx Management, we specialize in connecting people with the tools, and information they need to make the best decisions for the populations they serve.  This event serves as a forum for nationally recognized payers, oncologists, and industry thought leaders to explore and discuss the key issues and challenges we face in an evolving specialty market.  Along with general topic presentations we also have a few interviews and panels for even more information-sharing discussions designed to provide an environment of teamwork and strategic information sharing.

MHI: Who typically attends the specialty summit?

PV: The Specialty Summit is designed especially for health plans, employer groups, states, third-party administrators, oncologists, practice managers, brokers, consultants and pharmaceutical manufacturers.

MHI: What are you most excited about this year?

PV: This year’s program is packed with timely insights from thought leaders across the specialty landscape and is designed to shine a light on the emerging trends and effective solutions in this evolving specialty market.

From its beginnings 14 years ago, this conference has exploded in terms of attendance and the caliber of our programming. This year, we’re expecting over 600 attendees, with numerous opportunities to network and meet with our peers, as well as compelling programming and dialogue around the most pressing topics in our industry. I’m particularly looking forward to the presentations and discussions about the oncology landscape, the Affordable Care Act, biosimilars, and medical pharmacy.  Our keynote Dr. Matt Iseman is going to be pretty spectacular too!

MHI: Any closing words?

PV: We are thrilled to again be hosting the 14^th Annual Specialty Summit.  At Magellan Rx, we are proud to be pioneers in specialty pharmacy management. By leveraging our industry-leading expertise and value-driven solutions, we help our clients solve their specialty pharmacy challenges. Our passion is to help people live more vibrant lives and to motivate them to take better control of their health.

Learn more about the Specialty Summit

A study by a team of Magellan researchers, demonstrating the pervasiveness of opioid addiction, was presented at the American Psychiatric Association (APA) Annual Meeting, and was also the subject of an article by Clinical Psychiatry News.

The study, an analysis of medical and pharmacy data from 2009—2012 for 2.5 million people aged 20-64 who were part of a commercial health plan, showed that 48 percent of patients who had stopped using opioids for at least six months went on to use them again.

Dr. Shareh Ghani, vice president medical director at Magellan Healthcare, and lead author of the study spoke of the importance of fully understanding the scope of the addiction crisis: “Having worked in commercial and Medicaid markets, I have reviewed numerous cases of accidental overdose and suicides related to pain prescriptions. The opioid crisis in this country demands that we understand the issue and identify predictors of risk.”

Study co-author Gowri Shetty, vice president of analytics, underscored the importance of the work: “This study helped us understand the clinical characteristics associated with long-term and persistent opioid use and provided a better understanding of how to tailor interventions targeting those at increased risk of inappropriate opioid use.”

The opioid crisis remains a key area of research and development across Magellan Health. You can read the article by clicking here to visit the Clinical Psychiatry News website.