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.

According to the Kim Foundation, one out of four Americans experiences behavioral health issues. Of those, 60 percent are not receiving treatment.

Why are so many people not receiving treatment?

What does this mean for providers?

What more can be done to increase access to behavioral healthcare?

Learn more about this issue by downloading Magellan’s new infographic, “Mind the Gap: Increasing Access to Behavioral Healthcare.”

The full extent of this remarkably negative 2016 Presidential campaign might surprise you. Studies show that the campaign may have had a profound effect on the mental wellbeing of many people. This goes beyond the usual split of people who feel excited or disappointed following the outcome of any election. Across the country, healthcare providers are reporting an increase in patient stress.

It should be noted, this is not simply a result of the conclusion of the campaign. In October, the American Psychological Association reported that 52 percent of American adults identified the 2016 election as a very or somewhat significant source of stress. Worryingly, that announcement was based on a survey conducted in August when the final, and most contentious, part of the campaign was just getting started.

According to the APA survey:

• Across party lines, those registered as Democrats (55 percent) and Republicans (59 percent) are statistically equally likely to say the election is a very or somewhat significant source of stress.
• Nearly 4 in 10 adults (38 percent) say that political and cultural discussions on social media cause them stress.
• Men and women are equally likely (51 percent vs. 52 percent, respectively) to say the 2016 U.S. presidential election is a very or somewhat significant source of stress.
• Millennials and “matures” are the most likely to say the election is a very or somewhat significant source of stress (56 percent vs. 59 percent, respectively) — significantly more than Generation Xers (45 percent) but not boomers (50 percent).

In fact, the APA found that people were so stressed that it saw the need to release coping tips relating to the election.

Interestingly, given the result of the election, researchers have found that stress is not just limited to liberals. In an article for Wired, Maimuna Majumder a computational epidemiology research fellow for HealthMap at Boston Children’s Hospital explained that “some findings are consistent across red, blue, and swing states. Among them is the fact that increased searches explicitly for “presidential election” seem to be associated with searches for depression and anxiety, which suggests that the 2016 presidential election cycle may have been a source of emotional distress for Americans, irrespective of political leaning.”

Where is this election stress having an impact?

Day-to-day, one of the most noticeable places where this stress is felt is in the workplace. A noticeable change in this election, compared to those in the past, is a willingness to discuss it at work. In the APA survey, nearly half (47 percent) of all respondents said people are more likely to discuss politics in the workplace this election season than in the past. With these types of discussions happening in the workplace, employers are rightfully concerned about what all of this is doing to their workforce.

In short, a high level of employee stress does not lead to an engaged, productive workforce. In fact, the result is very much the opposite. According to a study by Fairleigh Dickerson University, “Workplace stress costs U.S. employers an estimated $200 billion per year in absenteeism, lower productivity, staff turnover, workers’ compensation, medical insurance and other stress-related expenses.” Other estimates, put the number at more than $500 billion. Studies have shown that businesses with a high-stress or high-pressure environment spend as much as 50 percent more than average on healthcare. There is also a strong link between high employee stress and low employee engagement.

Supporting Employees through External Stressors

Whether it is an election or a traumatic event or emergency, there are always going to be external events that are impossible to control. It is however, feasible to provide an environment and toolkit for employees to allow them to better manage their stress levels and emotional well-being.

Employers should lean on their Employee Assistance Programs (EAP) to provide resources for employees who are feeling stressed by the election (and the rest of the news cycle). This can range from simple advice about how to manage stress to more holistic therapy options. An EAP can also provide guidance and training for management-level employees for creating a cohesive and inclusive workplace.

You’re buying a car. Before you hit the lot, you do your planning and research, establish a budget, figure out what features you want and what style you’re looking for. You probably search online for car and dealer reviews, prices and sales. Based on all of that work, you make a decision, negotiate and pay for your new car.

Your car research was relatively easy. But finding a healthcare provider? Not so much.

While you may know what you want in a provider, very little information is available about the services they provide, appointment costs, reviews and other important details to help you make an informed choice about your care. And if you ARE lucky enough to find someone who seems to fit your needs, you’re often still left wondering what kind of quality you can expect from your treatment experience.

The bottom line is that it’s easier to buy a car than it is to find a healthcare provider. Silly, right? We think so, too – which is why Magellan is bridging these information and quality gaps by employing value-based purchasing models.

Rewarding quality care yields informed choices

Value-based purchasing takes various forms. But it generally operates on the premise that aligning providers’ incentives and reimbursement with organizational and individual goals incents behavior and drives positive outcomes, ultimately benefiting all involved in the healthcare continuum. This includes consumers, customers and payers, in addition to the providers themselves, who also enjoy improved reputations through public reporting.

In fact, one of the key tenets of Magellan’s value-based collaboration and purchasing models is to ensure stakeholders become more informed as a result of these initiatives:

• Customers benefit by knowing whom to partner with for network management;
• Payers benefit by knowing whom to pay for value; and
• Consumers, of course, benefit by having those online provider reviews become a lot less elusive, enabling them to make an informed decision about whom to choose for their care.

Magellan’s models also center on:

• Engaging and empowering providers in compensation model evolution. We partner with provider leaders around compensation design, employ transparency to ease the compensation shift and create meaningful incentives for providers to encourage active engagement. (1)

• Building provider compensation for an evolving healthcare market. Our priorities center on population management, team-based care and member access. We integrate new quality and efficiency standards into compensation, and remove compensation barriers to population goals. (1)

Why do we give value-based purchasing strategies the green light?

Take our Assertive Community Treatment (ACT) program as just one example. Through program data analysis and close collaboration with our ACT provider teams, we developed a three-tiered rate structure based on overall program goals to support recovery, wellness, and to improve community tenure. As a result, we saw a 21 percent decrease in inpatient admissions and a 24 percent decrease in the inpatient readmission rate.

Our drive for engagement continues

Providers nationwide are in different phases of readiness, so we keep our wheels in motion by providing a graduated maturity model to move them from the most basic stage—learning the behavior through activity incentives—to the most complex arrangements, which transform care delivery through outcomes-based incentives or other payment structures (2). We look forward to working with stakeholders, providers and consumers as we continue to expand this innovative and exciting model.

(1) Medical Strategy Group Council: “Next-Generation Physician Composition,” The Advisory Board Company

(2) Physician Quality Reporting Initiative: The Advisory Board Company

Millions of people are challenged by drug and/or alcohol use, which may result in physical and emotional health concerns. Many individuals feel like they have lost control and struggle with depressive signs and symptoms, in addition to substance use – and only a fraction of these individuals receive care, according to a report on addiction released in November by the U.S. Surgeon General.

At Magellan Health, our clinical methodology for the management of substance use incorporates leading principles of care, involving appropriate assessment, evidence-based interventions, as well as close collaboration with other healthcare providers who are vital to the delivery of effective care. At the core of Magellan’s interventions for substance use is our suite of computerized cognitive behavioral therapy (CCBT) programs powered by Cobalt Therapeutics, as well as screening software, and optional wraparound telephonic support.

Magellan’s Cobalt platform includes online, well-studied programs proven to help individuals who are coping with various behavioral health conditions. Among our Cobalt CCBT programs is SHADE – a 10 session mobile and web-based program for individuals living with alcohol, and/or drug use and co-morbid depression. SHADE provides skills-building exercises, which include mood monitoring, problem brainstorming, pros and cons analysis, planning for change, identifying problematic thought patterns and developing effective drug refusal skills. SHADE helps participants control their substance use, alcohol use and low mood by promoting long-lasting skill-based changes in behavior and thinking.

Published in the journal Addiction, SHADE has been proven in randomized, controlled trials to:

• Be comparable in efficacy to face-to-face therapy.
• Reduce hazardous drug and alcohol use by 44-58 percent after 6 months.
• Reduce hazardous use by 72 percent after 12 months.
• Significantly reduced binge drinking.

SHADE was listed favorably among the technology assisted interventions highlighted by the surgeon general’s report as a tool designed to “(1) increase access to care in underserved areas and settings; (2) free up time so that service providers can care for more clients; (3) provide alternative care options for individuals hesitant to seek in-person treatment; (4) increase the chances that interventions will be delivered as they were designed and intended to be delivered; and (5) decrease costs” (see https://addiction.surgeongeneral.gov/ for more information).

You can learn more about Magellan’s Cobalt CCBT capabilities here:

Magellan’s self-guided Computerized Cognitive Behavioral Therapy from Magellan Health on Vimeo.

As we pass from one year into the next with celebration, it can be a terrific time to reset, reframe and evaluate how we’ve been living. Do you feel run down on a regular basis? Do you feel unsatisfied with your career or personal relationships? Is there something that is weighing on your confidence? If enough dissonance exists between how we wish to live and how we’re currently going about our daily lives, the gap can begin to weigh on our happiness, health and sense of identity. It’s important to realize that to struggle with this dissonance from time-to-time is to be human, but there are a few simple tips you can take on to gradually reposition thoughts and make progress toward living a more satisfying, mindful life in the new year.

1. Prioritize connecting with family and friends. While it’s easy to get consumed with shopping for just the right gift, making the house “just-so” and achieving an Instagram-worthy holiday or party scene, try to steal a few minutes in your day to press the pause button. Savor your coffee, close your eyes and think about the valued relationships in your life. Make time for a quality visit, phone call, or send a card, text message or social media message to someone you fell out of touch with – just to wish them well and ask how they are. Knock on an elderly neighbor’s door, or look up and notice someone in your path that may be in need of a connection, and offer a friendly conversation.

2. Evaluate your self-care routine. When we think of healthy habits we aspire to adopt, we often look at the physical habits we can improve on – regular exercise, balanced diet, more water and sleep. Every year, many people begin with a resolution to finally tackle the mystical formula of being able to incorporate these habits into their daily life. While the holidays can be a great time to schedule that annual physical to check-up on your physical self, make sure you’re also scheduling in time to identify why it’s been difficult to achieve your goals and what you specifically need in order to feel strong and resilient. How do you feel about yourself? What are some negative influences in your life? Being honest about these questions can help you pinpoint how to move forward and incorporate ways to take care of your mental and emotional needs along with the physical. Your self-care routine will be unique to you, whether it’s recognizing that you need more quiet time in your day, or that your current situation leaves you feeling socially-isolated. Discovering what’s truly bothering you can feel very freeing, and offer a clearer picture of how to move forward.

3. Talk to someone proactively. Whether it’s a friend, family member, or a professional therapist or coach, exploring your feelings and the way you react to life stressors with an objective third party can help you step back and observe your needs in a different light. We often limit ourselves unconsciously with thinking patterns, views and behaviors that we’ve built on through the unique experiences in our lives. Recognizing the ability to look at things from a different perspective before we find ourselves in a serious state helps us to build that mindfulness muscle – helping us to cope better with challenges, react in constructive ways and practice resiliency. If you’re hoping to speak with a professional, there are now more options than ever to access them. Employers often offer a series of free and confidential coaching or counseling sessions as part of an Employee Assistance Program. If you struggle with transportation or have a packed schedule, or would like to experiment with different types of support, there are also a growing number of online options that can be sought out at any time of day – from online cognitive behavioral therapy programs (CBT), to text or video therapy or coaching, and many mobile apps that can help you track and practice positive daily habits (search for “meditation” or “mindfulness” in your app store, for example.)

4. Think about how you handle change. Change is constant and often feels disruptive to our lives. Whether it’s broader, societal change that we observe, or more personal life events – changing jobs, moving to a new location, or having a new child, change affects us all differently. It may interrupt our ability to fall asleep at night. It may even induce feelings of fear and anxiety. It may force us to evaluate how to think about ourselves and our relationships. Stepping back and taking a look at how we react to change helps us to be more mindful of the constructive steps we can take to alleviate worries and rise above negativity. Practice reframing what you hear and be open to looking at a situation from all perspectives. Think about different options you have in your reactions, and try to be empathetic to those that may have a different reaction to the same situation. Acknowledge others’ feelings as valid – even if they are different from yours. Lastly, it’s important to focus on aspects of a situation that you can control and impact positively, and to lessen time worrying about things you cannot. There are situations where you’ll have to take things as they come and allow things to happen.

5. Practice failing well. Chances are, you’ll be making some important life choices this year. Maybe you’re helping your child choose which major to take in school. Maybe you’re evaluating your own education and career options. Maybe you’re looking to deepen existing relationships, or find a fulfilling new one. Self-doubt inevitably can creep in and interfere with your ability to achieve these goals and make helpful decisions. Failing well is a skill, and learning to cope with and navigate failures will do wonders for your confidence and knowledge about yourself. Many successful people have shared that they’ve succeeded because of their failures and ability to find their strengths through them.

In the words of all-star NBA player, Michael Jordan:

“If you’re trying to achieve, there will be roadblocks. I’ve had them; everybody has had them. But obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it. I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. Twenty-six times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.”

We at Magellan wish you a happy, healthy and more mindful 2017!

When you think about giving back this holiday season, remember those persons serving as caregivers for the loved ones in your life.  Caregiving is one of life’s highest honors, but on the flip side it can also be physically and emotionally draining, especially during the holidays.  The added stress of having to balance holiday activities like shopping and visiting relatives and friends with caregiving responsibilities can be overwhelming, and may leave caregivers feeling frustrated, isolated, depressed and exhausted.

Caregiving today affects almost everyone – over 43 million adults in the United States have provided unpaid care to an adult or child in the past 12 months.

Bring a little joy to the world

There are a number of things you can do to help ease the burden for the caregivers in your life.  Here are some suggestions:

• Ask how you can help – This is the simplest approach. Begin by recognizing the caregiver’s role and ask about her or his concerns during the holiday season.  If you encounter resistance because the caregiver doesn’t feel that responsibilities can be set aside, make some suggestions about ways you can help without causing more stress.  For example, you could talk about family activities –are they able to attend, is the timing convenient, is there something you could do to help them prepare?
• Provide respite – Caregivers have their own holiday tasks to accomplish and more importantly, they need time to take care of themselves.  You could sit with a loved one for a few hours or help schedule in-home care for a period of time.  Perhaps spending time with the caregiver is the break they need.  Get together for coffee and companionship.
• Offer your services – With numerous responsibilities, there are bound to be a few things on the back burner that you could help a caregiver with.  Ask about needed home repairs, installing equipment to make their life easier or making a trip to the store or post office.  Could you assist with shopping or addressing holiday cards and getting them in the mail?
• Simplify traditions – Just because you’ve always done something doesn’t mean that the tradition must continue exactly as it was. Adapting activities to make them less stressful – and more enjoyable – is a win-win for everyone involved.  Plan ahead to ensure the space and timing is conducive. Something as easy as eating earlier in the day could benefit transportation arrangements, or keep caregiving needs on schedule.

Don’t limit recognition of the caregiver to the holidays.  The fact that you care enough to recognize the unique situation, the work performed, and to reach out may be enough to give the caregiver joy.  A burden shared is a burden lightened.

Keep up the good work

While holiday stress happens once a year, family caregivers are at an increased risk for burnout, depression, substance abuse, chronic illness and a host of other maladies year round.  In addition, there are a variety of caregiving situations that require special support, including long-distance caregiving and those caregivers in the sandwich generation who are caring for parents and their own children at the same time.

Check out the following tips and resources to see how you can support caregivers:

Long Distance Caregiving 

The Sandwich Generation

Finding and Choosing Respite Care Services

Caring for the Caregiver

10 Fast Facts About Caregivers