Although 21% of U.S. adults have a mental illness, access to behavioral healthcare remains out of reach for most. From 2008 to 2019, the number of adults with any mental illness increased nearly 30%. The pandemic further exacerbated mental health problems for adults and sparked an expanding youth mental health crisis. As the demand for behavioral healthcare continues to grow, Magellan Healthcare recognizes the need to increase access.

Increasing Access to Evidence-based Care

Magellan has collaborated with NeuroFlow, an award-winning behavioral health technology company, to increase access to our evidence-based digital cognitive behavioral therapy (DCBT) programs and enhance engagement. With a history of over 20 years of research and development and an endorsement from the Substance Abuse and Mental Health Services Administration (SAMHSA), Magellan’s DCBT programs are integral components of our Digital Emotional Wellbeing program, including FearFighter® for anxiety, panic and phobia and MoodCalmer for depression. Both programs, as well as RESTORE® for insomnia and other difficulties sleeping, are available online in Spanish, further increasing access to evidence-based programs.

Understanding Digital Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a short-term intervention that behavioral health clinicians use to help individuals overcome negative thoughts and behaviors. CBT is effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. CBT has been demonstrated to be as effective in certain conditions as other forms of therapy or psychiatric medications. Digital CBT (DCBT) is the implementation of CBT on a digital platform with the same core principles, language and exercises used in live practice that include:

• Learning to recognize thought distortions
• Evaluating distortions against reality
• Gaining a better understanding of others’ behavior and motivations
• Using problem-solving skills
• Developing a greater confidence in one’s own abilities
• Changing behavioral patterns
• Developing coping skills

True evidence-based DCBT follows the exact CBT process, differing from evidence-informed digital programs that use some CBT practices but are not built with fidelity to the intervention model. Learn more about evidence-based vs. evidence-informed behavioral health interventions here.

Impact of FearFighter and MoodCalmer on Mental Health

Our collaboration with NeuroFlow has yielded remarkable outcomes that underscore the power of innovative partnerships. In a recent study, members participating in the Digital Emotional Wellbeing program who completed 75% or more of FearFighter and MoodCalmer reported significant reductions in anxiety and depression symptoms within 90 days.

• FearFighter users experienced a 41% average reduction in Generalized Anxiety Disorder Assessment (GAD-7) scores, compared to other DCBT users who averaged an 11% reduction in GAD-7 scores.
• MoodCalmer users experienced a 24% average reduction in Patient Health Questionnaire (PHQ-9) scores, compared to an average 13% reduction among those who completed less of the program.

Beyond these impressive results, Magellan has seen a 124% increase in registrations after launching Digital Emotional Wellbeing over previous programs. Members also report high levels of satisfaction with the Digital Emotional Wellbeing program with 85% indicating they would recommend the program to someone else.

Visit Magellanhealthcare.com/digital-bh/ to learn more about the results and how our Digital Emotional Wellbeing program, including our award-winning DCBT programs improve anxiety, depression and more.

Sources:

• Exploring Barriers to Mental Health Care in the U.S. | AAMC
• What is Cognitive Behavioral Therapy? (apa.org)
• Satiani A, Niedermier J, Satiani B, Svendsen DP. Projected Workforce of Psychiatrists in the United States: A Population Analysis. Psychiatr Serv. 2018 Jun 1;69(6):710-713. doi: 10.1176/appi.ps.201700344. Epub 2018 Mar 15. PMID: 29540118.

FearFighter® and MoodCalmer are owned by CCBT Limited Corporation, United Kingdom. CCBT has granted Magellan exclusive rights to FearFighter® and MoodCalmer in the U.S.

Post Traumatic Stress Disorder, commonly known as PTSD, comes in many forms and affects children and adults alike. Early descriptions of PTSD are found throughout literature. The hallmarks of war-related PTSD were described in Homer’s The Iliad. Shakespeare wrote of the symptoms in Henry IV and A Midsummer Night’s Dream. In recent times, books such as The Things They Carried (Tim O’Brien) describe the effects of war and the risk for PTSD-related suicide. Movies such as Ordinary People and Mystic River portray the effects that loss and abuse have on families and individuals. The daily ease of access to images on the internet and television puts the fodder for PTSD in front of all exposed to electronic media. We have only to listen to the news to learn of all the possible inputs that can cause PTSD—the tornado that sweeps through a Midwest town, atrocities happening to people in places such as Syria, beheadings, and stories of abused children. PTSD can affect one individual at a time, or a lone event can bring PTSD into the lives of many with a single swath.

Prevalence of PTSD in the U.S.

PTSD is common. The lifetime prevalence of PTSD among adult Americans is 6.8 percent (National Comorbidity Survey Replication). For adolescents, the six month prevalence was estimated to be at 3.7 percent for boys and 6.3 percent for girls (Kirkpatrick, 2003). The prevalence is much higher among Veterans. Men and women who had served in the Vietnam War have a lifetime prevalence of 30.9 percent and 26.9 percent, respectively. Studies of Gulf War Veterans reported a current prevalence of 12.1 percent, and 13.8 percent for Veterans of Operation Enduring Freedom/Operation Iraqi Freedom (Kang, et al 2003; RAND Corporation 2008). Unfortunately, PTSD is often underdiagnosed in the medical setting—with symptoms being attributed to a “normal” response to a trauma, misdiagnosed as depression, or altogether missed because of the physical presentation of the condition.

PTSD Symptoms and Impacts

PTSD symptoms are not limited to only the emotional, but also bring physical impairment in many forms. The condition affects those people supporting the individual with PTSD, often causing distress to family, friends, and colleagues. It is important not to approach PTSD with a single point of view — the victim of a natural disaster may have different experiences and risk factors than a combat veteran, for example. What is the same, however, is a set of symptoms based in some form of exposure to a traumatic event, resulting in significant distress and impairment in an individual’s ability to perform in her or his roles, whether within family, employment, or other social units.

No matter the cause, the response to a traumatic event is similar, whether described in the 8^th Century BC, or in 2016. In 2013, the American Psychological Association updated the criteria used to diagnose PTSD. According to current diagnostic criteria, the diagnosis of and symptoms attributable to PTSD must include at least one month of:

• Direct exposure to a stressor; witnessing the stressor in person; indirectly learning of a loved one exposed to a violent or accidental circumstance; and/or repeated or extreme indirect exposure to aversive details of the event, typically by a professional exposed to the stressor (e.g. first responders)
• Persistent and intrusive re-experience of the event through memories, nightmares, flashbacks (e.g. dissociative reactions), distress after exposure to a reminder of the stressor, and physiological reactivity after exposure to a trauma-related stimuli (e.g. jumping up after hearing a door bang unexpectedly)
• Avoidance of distressing trauma-related stimuli, including thoughts or feelings, and/or trauma-related external reminders such as situations or people
• A negative effect on thoughts and mood, including an inability to recall features of the trauma; persistent negative beliefs; persistent and distorted self-blame and/or blaming others; persistent negative emotions such as fear or anger; diminished interest or pleasure in activities; feeling detached or estranged from others; and having a persistent inability to experience positive emotions
• Alterations in physiological arousal or reactivity including irritable or aggressive behavior; self-destructive or reckless behavior; hypervigilence; exaggerated startle response, problems in concentration, and/or sleep disturbance
• Distress or functional impairment in relationships, social, and occupational roles

What PTSD Feels Like

PTSD doesn’t always occur immediately after the traumatic event. In fact, in some cases, the diagnosis may not be made for up to six months with the gradual onset of the full symptoms. Some individuals with PTSD develop dissociative symptoms as the primary feature of the condition. Those affected describe a sense of being an outside observer or detached from oneself (depersonalization), and/or the sense that things are not real or are distorted (derealization). See the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition for a detailed description of the diagnostic criteria for PTSD.

Unfortunately, PTSD predisposes affected individuals to other behaviors that can be emotionally and physically harmful. Persons with PTSD are more likely than persons without PTSD to develop alcohol use disorder (AUD) and substance use disorder, including tobacco, pain medications, and illicit drugs. Nearly half of people with PTSD can suffer co-occurring depression. Physical symptoms and conditions associated with PTSD include cardiovascular conditions such as hypertension, pain, gastrointestinal symptoms, and musculoskeletal symptoms.

While it is very difficult to predict who will develop PTSD, some factors may increase the risk of developing the symptoms, including:

• Getting physically hurt during the trauma
• Seeing another person get hurt or killed
• Having childhood trauma
• Having a sense of horror or helplessness during the trauma
• Having little or no social support after the event
• Dealing with additional stressors after the event, such as losing a loved one, ongoing pain or injury, or loss of one’s job or home.

Taking Care of Oneself after Trauma

While trauma impacts everyone differently, there are some ways to reduce the risk of developing PTSD. Examples include:

• Seeking out support from other people, including friends and family
• Talking about the trauma soon after it occurs
• Attending a support group with others who may have had similar experiences
• Learning how to acknowledge and accept your actions in the face of the trauma
• Having a positive coping strategy; being able to act and respond effectively despite feeling fear

PTSD does not have a cure, but symptoms can be managed to help an individual function better in day to day life. The recommended treatment of PTSD largely is based on the use of medication and psychotherapy. The earlier treatment is started, the more likely the treatment will have positive effects. Combinations of medication, psychotherapy and support are typically the most effective way to ameliorate symptoms.

Therapy for PTSD

Several therapy types have been shown to reduce the physiologic responses to stimuli, or alleviate intrusive thoughts by teaching a person the skills to identify triggers in order to better manage their symptoms.

• Cognitive behavioral therapy has been shown to be effective in treating PTSD. In addition to educating people of their symptoms, cognitive behavioral therapy can also include prolonged exposure (PE) therapy to address the traumatic event. During PE one gradually approaches trauma-related memories, feelings, and situations that have been avoided since the trauma. By confronting these challenges, PTSD symptoms decrease.
• Novel treatments for PTSD include Eye Movement Desensitization and Reprocessing (EMDR). This is a form of psychotherapy that involves the patient paying attention to a back-and-forth movement or sound while thinking about the upsetting memory long enough for it to become less distressing. During EMDR, one learns about their physical and emotional reactions to trauma, targeting the upsetting memory, discussing the memory, and ultimately focusing on a positive belief or feeling while the memory is in one’s mind.
• Cognitive restructuring or processing therapy helps the affected person work through faulty memories of the trauma, and challenges their interpretations of the event, experience of the event, and beliefs that life is full of ongoing danger. Cognitive processing therapy teaches new ways to handle upsetting thoughts and to develop a new perspective on both past and future.

Other therapies include training in relaxation and anger-control skills, group therapy, couples therapy, family therapy, implementing an exercise program, and sleep hygiene. While often tempting in the short-term, it is essential to avoid self-medication with alcohol or other substances such as pain killers that often are habit forming, and may exacerbate symptoms.

When approaching our programs, we at Magellan recognize the importance of identifying PTSD symptoms early on. We hope to spread the understanding that one’s response to trauma does not reflect failure, or weakness in character. Rather, we believe that raising awareness and understanding of PTSD is essential to tackling this condition, which affects so many Americans. As we move forward in developing and integrating new programs, we are keenly interested in supporting individuals, families and healthcare providers to increase access to resources for PTSD education, treatment and support.

Looking for more information on PTSD support? Click here for a list of resources and tips, or call 1-800-273-TALK if you are in crisis.

There are many healthcare-oriented apps in the marketplace, but there are few out there that offer cognitive behavioral therapy (CBT) and that have also been built on a multi-decade foundation of program efficacy data. Magellan’s CBT apps engage participants in psychoeducational content and activities through interactive sessions designed to maximize self-management of behavioral health symptoms such as sleep, depression, and anxiety. We recently released three apps to the Apple App Store including RESTORE (for insomnia and sleep problems), FearFighter (for anxiety, panic, and phobia), and MoodCalmer (for mild to moderate depression) and have plans to release two to three more in the near future.

But what does it take to build and release these kind of apps?

First and foremost, teamwork.

The best apps, healthcare or other, are not built by one person. They require a team of individuals coming together to work towards common goals. Our primary team includes two product owners, and two project managers who collectively work to get the vision from senior leadership (e.g. sketching ideas, wireframing, developing a curriculum), and then oversee the development teams building the apps (e.g. writing user stories, participating in daily scrum meetings, recording and producing videos, providing feedback), and then ensure smooth and timely deployment of various iterations that get delivered to our customers (e.g. delivering training, scheduling releases, communicating upgrades). Without teamwork these critical processes could not be completed and the App Store would have three fewer apps.

Second, and also very important, user feedback.

We have tens of thousands of active users on our platform, and we know that the majority of individuals who do two or more sessions report improvements in their sleep and mood. Therefore, it is very important for us know how to keep our users engaged. To drive engagement we seek out users and give them the opportunity to give us feedback on what would make our apps more helpful and more useful. Importantly, our users do not just include patients, members, and consumers, but also clinicians, care managers, and providers. We investigate how they use our apps and what features they would like to have included.  We incorporate this user feedback into our development sprints using what are called “user stories.” User stories help keep us focused on the core needs of our users, and they give us clear actionable tasks that can gauge what makes our apps successful and can also determine development steps for future iterations. For example, when we started asking our users what they would like added to our apps’ user experience, we learned about different features they would like to see. To help frame those features from the user perspective, we listed them out in user stories, such as, “As a RESTORE user I would like my sleep diary data to sync with my sleep data in the HealthKit app on my iPhone, so that I can see how data from my wearable device aligns with the sleep goals I set in RESTORE.”  When we roll out features developed from user stories, we see our engagement grow from previous years, and we validate our overall approach.

Lastly, we need to measure, test, learn, and keep building.

Our apps include a lot of content, in both English and Spanish speaking versions. The primary psychoeducational components include video recordings of narrators and clinical vignettes. The videos vary in length, and for each video embedded in the apps (there are dozens) we need to measure the length, test how long we can keep users watching, and learn from their experience. We have found that some videos are more watched than others, and we have found greater acceptance with shorter video length. Aside from just the videos, we have run a battery of tests on the features embedded in our apps and platform. These tests help us work out the bugs and improve the overall user experience. Once we are satisfied with our testing, we determine our readiness for release. Apple is pretty thorough with its acceptance and release of apps to the App Store, and we were very pleased with the turnaround time. We are now preparing to release our apps to Google Play, and will also be releasing later iterations with enhanced graphics, text-based reminders, and other features recommended by our users. Ironically, our apps are both complete and never finished, but I look forward to seeing how our apps will evolve, and continue to lead individuals to more healthy, vibrant lives.

Magellan Behavioral Health of Pennsylvania, Inc., a Medicaid managed care organization (MCO), started as the new HealthChoices behavioral health exclusive contractor for the Cambria County Behavioral Health Services Program on July 1, 2017. Magellan currently administers behavioral health benefits for Medicaid members through HealthChoices contracts with Bucks, Delaware, Lehigh, Montgomery and Northampton counties.

Magellan has over two decades of experience managing behavioral health benefits for HealthChoices members through close collaboration with members, providers and community organizations. Through this collaborative mindset, Magellan has succeeded in producing innovative efforts in the following areas:

• increases in access to care
• improved service use rates
• expansion of the continuum of services in alignment with evidence-based models
• maximization of clinical appropriateness
• nationally recognized level of quality services

Read more about Magellan’s collaboration with Cambria County, local providers, community organizations and members in the Tribune Democrat: New Behavioral Health Provider Brings Options, Jobs to Cambria County.

It’s 11:30 on a Tuesday night in the emergency department of a local county hospital. The doctor pulls back the curtain on his next patient and frowns. He has seen this man before. He looks down at the chart and recognizes the name. He’d been in about eight weeks before with trouble breathing and chest pains. Gears click in doctor’s memory, as he recalls this patient. His medical work-up had shown nothing acutely wrong. He’d been encouraged to take his usual medications, and sent home with instructions to see his regular doctor as soon as possible to make sure his chronic diabetes and congestive heart failure were under good control.

The doctor pulls a stool across the floor and sits down bedside.

“Hi Brian, what seems to be the trouble?”

“My chest. I couldn’t breathe. And I can’t seem to concentrate. I just don’t want to do anything.” Brian’s voice is listless and low, and he looks fatigued.

“I see you were in a couple of months ago. Did you go and see your regular physician?”

Brian shrugs but doesn’t say anything. His eyes are fixed firmly on the floor.

The doctor pauses. He looks at Brian for a while. The man looks like he hasn’t taken care of himself. His clothes are wrinkled, and he’s lost some weight since his last visit to the emergency department. The doctor looks over Brian’s vitals and labs. He finds nothing concerning on physical exam. He asks, “Brian, has anyone ever talked to you about depression?”

In the case above, Brian is a fictional character, but the situation is not. The co-occurrence of mental health disorders with physical ailments is common. A Substance Abuse and Mental Health Services Administration (SAMHSA) report found that 68 percent of adults with mental disorders have medical conditions, and 29 percent of adults with medical conditions have mental disorders. The most common of these is depression. Many research studies have found high rates of comorbid depression with chronic and terminal medical conditions. In many cases, the medical conditions or treatments for the conditions can cause depression. In others, the depression itself can lead to health behaviors that cause or worsen medical illness, and even higher risk of death. For instance, persons with depression have higher rates of smoking cigarettes than the general public. This can lead to heart disease. But, depression itself can also cause changes in brain chemistry and platelets, which can worsen existing heart disease.

Common Conditions with Comorbid Depression

Comorbid depression in some medical conditions is common. According to the National Institute of Health, there is a close relationship between depression and other physical ailments:

• Alzheimer’s disease and other dementias
• Cancer
• Coronary artery disease
• Congestive heart failure
• Diabetes
• Epilepsy
• HIV/AIDS
• Multiple sclerosis
• Parkinson’s disease
• Rheumatoid arthritis
• Stroke
• Systemic lupus erythematosus

Depression also has a negative effect on treatment and outcomes for these diseases. A 2015 published research study showed those with comorbid depression had more negative outcomes for their primary ailment than those who only had the primary ailment. Research also shows a lower quality of life, lower compliance with medical treatments, and lower rates of exercise and healthy eating habits for patients with comorbid depression compared to those with the same physical ailment(s) who did not suffer from depression.

This comorbidity has consequences beyond the health of the patient. People with multiple medical conditions are a rapidly growing and extremely costly segment of the US population. Patients with behavioral health disorders spend more on treatment for general medical conditions. When compared to those without depression, overall health care spending for medical conditions is higher than those without, in addition to treatment for the depression itself.

Improving Care for Comorbid Behavioral Health Conditions

The first step is identifying patients with comorbid behavioral health conditions before they reach the dangerous and costly levels discussed above. The primary care setting may be the best place to first find depression. But how?

Magellan’s Screen and Engage program is an innovative, user-friendly application that primary care physicians (PCPs) can use to identify patients at risk for a mental illness. Using a Magellan-provided iPad, the patient answers questions about his or her health and well-being while waiting for an appointment. The screening tools are also available in Magellan’s Virtual Care Solutions. Magellan’s proprietary algorithms assess the results, identify potential behavioral health issues and suggest recommendations for treatment, and flag clinicians to engage the patients.

The benefits of the tool are clear. Given the limited amount of time that a PCP has for each appointment, he or she must focus the conversation on the primary reason for the visit. As such, there is little opportunity to probe for behavioral health concerns. By conducting the screening before the short appointment, the PCP has a chance to be notified of the screening results, and discuss them during the visit.

Screening for behavioral health conditions is just the first step. Step two is treating them. In general, depression is treated with either medications and/or cognitive behavioral (CBT) psychotherapy. CBT is a specific type of therapy that relies on identifying and changing ones thoughts that can lead to depression. Research shows that the combination of the two is better than either done separately. While it may be easy to receive anti-depressants from medical doctors, it is often difficult to find CBT.

Cobalt, Magellan’s computerized Cognitive Behavioral Therapy (CCBT) program, is a cost-effective solution to address common behavioral health conditions. Cobalt provides CCBT online or through a smartphone/tablet app. This makes face-to-face CBT—proven to work but often difficult to find providers, especially in rural areas and for working people—available anywhere, any time. It is also a more private approach to CBT. Patients can access treatment from their homes versus an office.

Computerized CBT has proven to be just as effective as in-person CBT. Magellan offers Cobalt modules for insomnia, depression, anxiety, substance use disorder and obsessive-compulsive disorder, treating more than 90 percent of behavioral health conditions seen in primary care and behavioral settings.

Tackling Comorbid Conditions for a Healthy Future

At Magellan, we have made it our mission to help individuals like Brian, whose case is all too common. Tackling comorbid behavioral health issues alongside common medical conditions is one way we do it. Investing in and using new technology, we can identify more people who need help and expand their access to effective, proven treatments.

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.

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.