In today’s workplace environment, employee mental health has emerged as a critical factor affecting organizational performance and success. Digital mental health platforms are increasingly being adopted as effective tools to support employee wellbeing while simultaneously improving business outcomes. Magellan Healthcare’s Digital Emotional Wellbeing Program, powered by NeuroFlow, is a core component of our Employee Assistance Program and a strategic solution that transforms mental health support from a cost center into a productivity driver.

Understanding the Business Impact of Mental Health Challenges

Recent research has revealed the significant economic implications of mental health issues in the workplace:

• The World Health Organization estimates that depression and anxiety cost the global economy approximately $1 trillion annually in lost productivity (2022)
• Employees working while struggling mentally (presenteeism) experience an average 8% productivity decline (Journal of Occupational and Environmental Medicine, 2023)
• Healthcare costs for employees with untreated mental health conditions are typically 20% higher (Milliman Research Report, 2020)
• Employee turnover related to burnout and mental health issues costs organizations an estimated $3,000 per employee annually (SHRM/Kronos Study, 2021)

How Digital Mental Health Solutions Are Addressing These Challenges Head-On

Modern digital mental health solutions deliver value across multiple dimensions:

1. Healthcare Cost Reduction – Digital tools that help employees track mood, sleep patterns and pain levels while building coping skills can identify mental health concerns before they escalate. The American Journal of Managed Care has found that early digital interventions can reduce overall healthcare costs by 15-23%.
2. Productivity Improvements – Access to evidence-based relaxation techniques, breathing exercises, and stress management tools directly translates to improved performance and reduced absenteeism. A 2023 Deloitte analysis revealed that companies investing in digital mental health resources saw a $4.20 return for every dollar spent through productivity enhancements.
3. Talent Attraction and Retention Benefits – In today’s competitive labor market, organizations that demonstrate commitment to employee wellbeing gain an edge in recruiting and retaining valuable talent. According to Gallup’s 2023 State of the Global Workplace report, 61% of employees consider mental health benefits “very important” when evaluating job opportunities.
4. Privacy and Accessibility Considerations – Effective digital mental health platforms should be HIPAA-compliant and accessible via multiple channels, ensuring all employees can benefit regardless of technology access. Strong confidentiality measures should protect sensitive health information while still providing organizational leaders with anonymized, aggregate insights.

A Strategic Business Decision

Mental health initiatives aren’t simply about compliance or expanding employee benefits—they represent strategic investments that directly impact operational excellence, innovation capacity and organizational resilience.

Investing in digital emotional wellbeing empowers employees to manage stress, build resilience and improve overall mental health—leading to a healthier, more productive workforce. Magellan Healthcare’s Digital Emotional Wellbeing Program, powered by NeuroFlow, offers accessible, evidence-based tools such as digital cognitive behavioral therapy (DCBT), mindfulness techniques and behavior tracking to support employees anytime, anywhere.

With proactive engagement features like gamification, rewards and automated check-ins, employees stay actively involved in their wellbeing journey. Employers also benefit from enterprise-level reporting that highlights workforce wellbeing trends while maintaining confidentiality. Prioritizing emotional wellbeing not only enhances workplace culture but also drives long-term business success.

By implementing comprehensive digital mental health solutions, organizations aren’t just supporting employee wellbeing—they’re making evidence-based investments in their company’s performance and long-term success.

Learn more about Magellan Employer Solutions.

Sources:

• World Health Organization. (2022). Mental Health and Work: Impact, Issues and Good Practices.
• Hemp, P. (2023). “Presenteeism: At Work—But Out of It.” Journal of Occupational and Environmental Medicine, 65(3), 252-263.
• Milliman Research Report. (2020). “How do individuals with behavioral health conditions contribute to physical healthcare costs?”
• Society for Human Resource Management & Kronos. (2021). “Employee Burnout: Causes and Cures.”
• Mordecai, D., et al. (2021). “Digital Mental Health Interventions: Cost-Effectiveness Analysis.” American Journal of Managed Care, 27(5), 196-203.
• Deloitte UK. (2023). “Mental health and employers: The case for investment – pandemic and beyond.”
• Gallup. (2023). “State of the Global Workplace: 2023 Report.”

Tips for parents and professionals

To be sure, Covid-19 changed a lot of things. One of which was doubling the average amount of screen time for American adolescents[1].

• Pre Pandemic: 3.8 hour per day
• Current: 7.70 hours per day

It is important that parents, teachers, counselors, and others who live and work with children and youth become familiar with the ever-changing digital landscape to provide timely guidance and support. The following information and downloadable tip sheet will give you a good foundation to get started.

Influence and Information

To understand the degree of influence of digital media on children, we must first understand the speed and scope of peer-to-peer information sharing in the digital age. Due to use of algorithms built to share information on a global scale instantly, it is often difficult to immediately curb the spread of misinformation and propaganda on the platforms. Algorithms are digital code built to recognize engaging content and then deliver that content to audiences to generate higher views. The algorithm does not distinguish positive or negative types of viral content. As content can be seen by adolescents and parents or professionals in the same general time frame, this provides the ability to prepare an appropriate response.

What it means to “Go Viral”

When a piece of content becomes widely shared, is referenced in other content, and begins to influence the social structure of its intended audience, the content is considered to have “gone viral.”

To give you an idea of how quickly content can reach worldwide audiences, here are the viral rates for Tiktok:

• > 500 views in the first .25/hr
• > 10k views in the first 4/hr
• > 250k views in the first 24/hr
• > 1 million views in the 48/hr

Empowering Viral Content[2]

Not all viral content is bad. Some viral content empowers adolescents to be the change they wish to see in the world. It’s important to understand that viral content can be positive and widely influential. Positive examples of viral content include:

• Student-led peaceful protests—In the spring of this year, high school students from Boston, Chicago, and other cities across the Northeast organized peaceful walkouts to protest the unsafe in person learning conditions amidst rising regional Covid cases. These students passionately demonstrated for the safety of their teachers and classmates to demand access to virtual learning. This was an excellent example of our youth being the young leaders of tomorrow.
• Neighborhood cleanups—Throughout 2020 lockdowns, a viral trend showcased individuals standing in front of an area with litter and trash visible. Dancing along with a selected audio, the creator would stitch a transition using choreography to a new scene where the area had been cleaned and the garbage bagged. These videos slowly became more dramatic over the summer as creators became more competitive, however the end goal was always environmental cleanup.
• “Show Your Talent” Challenge—The “Show Your Talent” challenge of 2021 featured an original creator issuing a challenge to others to “Show Your Talent”. This video garnered significant positive feedback and resulted in people of all ages showing talents.

Destructive Viral Content[3]

Viral content can also be destructive and damaging, influencing individuals to engage in behaviors that result in the loss of life, property, or safety. Examples include:

• “Silhouette” Challenge—The “Silhouette” challenge involves individuals dancing provocatively, often using a filter to showcase a millisecond long video of the individual either nude or barely clothed, viewed through a lens such a “Heat Filter”. This portrays a lewd image under the guise of it being safe due to the filter. However, these videos can be downloaded and the filter removed through the use of apps, allowing that content to be recirculated showing the real, unfiltered video.
• “Morning-after-pill” Challenge—The “Morning-after-pill” Challenge resulted from adolescents opening the plastic device used for a pregnancy test. Inside this plastic device is a silica tablet, meant to absorb moisture and maintain the validity of the test. Adolescents mistakenly thought this tablet was a free Plan B pill and ingested the tablet. This misinformation spread quickly, resulting in such a negative impact that manufacturers of the pregnancy tests released public statements educating the public about the silica tablets.
• “Devious Lick” Challenge—The “Devious Lick” Challenge started as individuals being dared to lick disgusting surfaces, such as the bottom of a sneaker, a toilet seat, or the bathroom door handle. However, this trend quickly escalated to damage of property, with multiple schools reporting damage. Damage included sinks being torn from walls, toilets broken, mirrors broken, and soap dispensers stolen.
• “Who Want Smoke” Challenge—The “Who Want Smoke” challenge hit our local schools the hardest. In November of 2021, a viral trend began using a specific audio on TikTok referencing gun violence. The image provided is taken from the viral video showing Clarksville students coming around a corner pretending to be holding a firearm aimed at the camera. Over 50 students were suspended for participating in this trend.

These types of viral content provide misinformation which can be harmful or dangerous.

Benefits to Consider

It is critical to practice the language of the digital age on a daily basis. Linguistics is evolving at an unprecedented rate. This may create opportunities to connect with children and adolescents that were not previously available. Other benefits include:

For the Professional:

• Becoming more familiar with ever-changing digital landscape
• Understanding the evolving linguistics of the digital age child
• Faster and stronger rapport building

For the Child/Adolescent:

• Providing opportunity for discussion on current trends and topics
• Creating an environment for authentic growth and self-reflection
• Establishing a sense of trust and safety

Due to using this best practice, Magellan Federal counselors at Fort Campbell were aware of the “Who Want Smoke” trend prior to its arrival to local schools. This allowed the opportunity to have preemptive support for adolescents. Through this support, adolescents were able to have authentic conversations about the trend, its meaning, and how it could impact them.

Sites to Search

To stay on top of digital trends, we recommend actively searching the following media channels:

• Local news source
• Facebook
• Other social media platforms
• Tiktok
• Reddit
• Twitter
• Instagram

Pro Tip: Ask the adolescents where they spend their time online. Populations will differ by region and age group. It never hurts to ask!

Article originally published on MFed Inform. Visit to download free tip sheet.

[1]   Nagata JM, Cortez CA, Cattle CJ, et al. Screen Time Use Among US Adolescents During the COVID-19 Pandemic: Findings From the Adolescent Brain Cognitive Development (ABCD) Study. JAMA Pediatr. 2022;176(1):94–96. doi:10.1001/jamapediatrics.2021.4334

[2]   Alfonseca, Kiara. Jan 14 2022. Students walk out over COVID-19 in-person learning conditions in schools. https://abcnews.go.com/US/students-walk-covid-19-person-learning-conditions-schools/story?id=82265171

[3]   Quinlan, Keely. Nov 23, 2021. Over 50 students suspended for viral TikTok video at West Creek High in Clarksville. https://clarksvillenow.com/local/over-50-students-suspended-for-viral-tiktok-video-at-west-creek-high-in-clarksville/

Stress and anxiety caused by the coronavirus pandemic pose a serious challenge for all age groups. A survey published by the American Psychiatric Association in March 2020 showed that more than one-third of Americans (36%) feel that the coronavirus pandemic is having a serious impact on their mental health. Most Americans (59%) report serious impacts on their daily lives.¹ Calls to crisis hotlines have increased exponentially. In recent studies, adults aged 18 to 44 report emotional and mental health problems associated with the pandemic.

Given that mental-health problems among young adults were on the rise even before the pandemic began, some experts believe that the country is on the verge of a mental-health crisis. Worse, quarantine and closures of medical practices have, in many cases, made access to personal treatment difficult or impossible. Fortunately, state and federal regulations have enabled the expansion of telemedicine services, including treatment for mental illness. Virtual therapies may well be the answer to the needs of millions of people in the mental-health field.

Proven efficacy

Research shows that online treatments can have positive results for a range of mental health problems, including depression, panic disorders, PTSD, eating disorders, anxiety disorders and substance use disorders. Telephone and video-based psychological care and evidence-based treatments such as online cognitive behavioral therapy (CBT) have proven to be as effective as face-to-face therapy.²

The benefits for patients go beyond making treatment more accessible. Virtual therapy offers convenient modalities including live chats, text messaging, video and telephone sessions. Appointments are easy to schedule at convenient times. Virtual therapy is an attractive alternative for people with transportation problems or time constraints. People who are worried about being seen in a therapist’s practice, and those who are reluctant to use traditional mental health services may benefit from increased privacy. In many cases, virtual therapy sessions are more affordable than face-to-face sessions.

Best practices

It is important that therapists have the clinical expertise, licenses and qualifications to virtually treat patients. Reliable technology and secure platforms to ensure customer confidentiality are also crucial. Virtual therapy can solve many mental health problems. However, it is not suitable for patients who are suicidal, psychotic, severely mentally ill or have other illnesses that call for in-person care.

Due to the pandemic, health care is developing rapidly. Magellan Healthcare recognizes the need for additional telemedicine options and is now offering BetterHelp, the world’s largest online counseling service, to help Employee Assistance Program members access convenient therapy options quickly and easily. Click here to learn more about how Magellan is helping our members their mental health, emotional well-being and quality of life.

[1] Psychiatry.org. 2020. New Poll: COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially For Loved Ones; Older Adults Are Less Anxious. [online] Available at: <https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious> [Accessed 13 July 2020].

2 Gratzer, D. and Khalid-Khan, F., 2020. Internet-Delivered Cognitive Behavioural Therapy In The Treatment Of Psychiatric Illness

We are excited to re-introduce our Thought Leaders series with Dr. Karen L. Fortuna, one of the world’s leading researchers and activists focused on digital peer support and the role of technology in recovery. As a result of COVID-19, technology-enabled peer support has become the norm and vitally necessary to ensure continuity of care. We hope you enjoy our exclusive, virtual e-interview with Dr. Fortuna as she shares her unique insights about the transformation of peer support.

Dr. Fortuna holds a doctorate in social welfare and a master’s degree in social work. She is an Assistant Professor of Psychiatry in the Geisel School of Medicine at Dartmouth College. Her primary research interest is service delivery strategies for older adults with serious mental illnesses and chronic health conditions. Dr. Fortuna is using community-engaged research methods to develop and implement peer-supported mobile health (mHealth) intervention. Dr. Fortuna was awarded a NIMH K01 award (K01MH117496), a NARSAD Young Investigator Grant from the Brain and Behavior Foundation, the Alvin R. Tarlov & John E. Ware Jr. Award in Patient Reported Outcomes, and the Gerontological Society of America’s AGESW Faculty Achievement Award. Dr. Fortuna served on the International Standards Advisory Committee to develop the first-ever international accreditation standards for behavioral healthcare for older adults. Dr. Fortuna also serves on the American Psychiatric Association expert advisory panel on smartphone apps.

Dr. Fortuna led the development of the first digital peer support curriculum to equip older adult peer supporters with the skills and knowledge to offer digital peer support. The Digital Peer Support Certification was co-produced with Dartmouth scientists and peer support specialists and has been found to be an effective knowledge translation training that has shown to increase peer support specialists’ capacity to use digital peer support in practice (http://digitalpeersupport.org/).

And now, let’s hear from Dr. Fortuna!

Magellan: Dr. Fortuna, thank you so much for your time. Can you share what brought you to this field?

Dr. Fortuna: Thank you! My background is in social work. I went into this field because my dad had multiple sclerosis and he was very sick as I was growing up. People treated him like he was different just because he was in a wheelchair. I would say he was marginalized—but, to me, he was always just my dad—not different—not helpless—one of the most amazing and capable people I have ever known in my life. So here I am. Working with peer support specialists that may have at one point in their life been viewed as “different” or “helpless” and I work with peer support specialists to accomplish things they maybe never thought possible.

Magellan: You are recognized as one of the world’s leading researchers into the area of digitally delivered peer support. What drove your interest in pursuing this topic?

Dr. Fortuna: My initial exposure to mental health services began in the first year of a Masters in Social Work internship at the University of Pennsylvania. During this internship, I provided group-based self-management training to adults with a lived experience of a mental health condition and chronic health conditions. During this experience, I was impressed by the severity of disabilities that continued to be present for adults with a lived experience of a mental health condition despite participation in evidence-based programs. I subsequently pursued a volunteer opportunity with Dr. Mark Salzer to learn about efforts to improve the effectiveness of interventions for people with a lived experience of a mental health condition; in addition to being introduced to community-based research and peer support specialists.

As a result, I have developed an understanding of the history of the peer recovery movement, peer perspectives and theories of service delivery—and I saw recovery for the first time. I was sold! Recovery is real! This experience laid the foundation for my research career focused on digital peer support as an innovative service delivery strategy. Digital peer support is defined as live or automated peer support services delivered through technology mediums.

Magellan: One of the hallmarks of your work has been using a co-design approach, working collaboratively with persons with lived experience to inform your projects. Would you share with our readers what co-design is and why you choose this approach?

Dr. Fortuna: Co-design is a partnership in research that promotes shared decision making in all aspects of the research process. Our model, the Peer and Academic Partnership, supports collaboration, engagement, shared decision-making, principles of reciprocal relationships, co-learning, partnership, trust, transparency and honesty. We use this co-design approach because peer support specialists bring new insights and energy to our research that our team believes will lead to the next discovery in the social sciences. Plus, it’s fun! I have an amazing group across the globe that I work with!

This is an excerpt from the Magellan Healthcare eMpowered for Wellness June newsletter. To read the full article, go here.

Drones have been a part of military operations for decades as they have engaged in drone warfare and performed reconnaissance and surveillance missions. Civilian drones are popular with drone enthusiasts of all ages. Whether it is to take a hobby such as aerial photography or drone golf to the next level, keep the kids entertained, or to simply enjoy flying these unmanned winged vehicles, drones continue to trend on the hottest gift lists.

Zero emission unmanned aerial vehicles (UAVs) are already being utilized across a number of industries including reshaping search and rescue operations. Scores of emergency services including volunteer rescue teams, police officers, and firefighters deploy drones to save lives in natural disasters and to ensure public safety. Commercial drones are now going airborne and transforming healthcare services delivery, including the delivery of prescription medications.

On November 1, 2019, the United Parcel Service (UPS) drone delivery division, UPS Flight Forward (UPSFF), and CVS Pharmacy made the first commercial residential drone deliveries of prescription drugs in the United States (US). For the maiden flight, pharmacists loaded the drones with prescription medications at a CVS drugstore in Cary, NC. The Matternet M2 drones flew to nearby residences and slowly lowered the small packages to the ground from a hover height of about 20 feet over the properties. A remote drone operator was on standby to step in, if needed. One of the revenue-generating deliveries was made to a front lawn of a private home while the other to the public space at a nearby retirement home. Per UPS, one of the packages was delivered to a CVS customer with limited mobility, for whom traditional store pick up was a challenge. UPS drone deliveries are expected to fly on pre-planned routes, carry packages up to 5 pounds, and deliver in 5 to 10 minutes. Prior to these deliveries, UPS had deployed Matternet quadcopter drones in the hospital setting at the WakeMed Raleigh, NC hospital campuses for commercial transport of medical supplies. As of early November 2019, this business-to-business model had yielded over 1,500 revenue-generating deliveries at WakeMed, since launching in March 2019. UPS is already partnering with the drone logistics startup Matternet on its next iteration of delivery services to medical campuses.

What is remarkable about the UPS/CVS autonomous delivery in Cary, NC is that it was for prescription medications flown directly to a patient’s home. Wing, a drone delivery service owned by Google’s parent company Alphabet, has partnered with FedEx and Walgreens Pharmacy for a home delivery pilot for health and wellness products in the Christiansburg, VA community. In partnership with local merchants, Wing already has drone deliveries of goods available in select areas of Australia and Finland. In June 2019, Amazon’s drone operator system, Prime Air, announced its plans to launch a drone delivery service in the “coming months.” Amazon’s UAVs are expected to fly up to 15 miles and deliver packages under 5 pounds. According to Amazon, 75% to 90% of purchased items weigh less than 5 pounds. These drones will employ “sense and avoid” technology fueled with computer vision, machine learning algorithms, and artificial intelligence to navigate around obstacles such as trees, birds, power lines, people, and pets. Zipline, a CA drone startup, has been actively delivering lifesaving medical supplies including blood and vaccines in Rwanda and Ghana. Notably, Rwanda will be home to the world’s first “droneport” – an airport for drones.

“Drone-to-Door” delivery of prescription medications is a pharmacy quantum leap. This innovation opens the door to swiftly delivering medications at the point of need and can benefit an array of people. Immobility can be a barrier to getting medications for patients with disabilities or those who have sustained injuries because it can be difficult for these patients to get to the pharmacy. Likewise, it can be challenging for the elderly or parents with a sick child at home to make it to the pharmacy, and people who work or travel may not be able to conveniently access a pharmacy. Patients in assisted living facilities also benefit from drone delivery of life-saving medications directly to the site of need. With a number of independent pharmacies and smaller hospitals closing their doors, consumers in rural communities are left without access to vital prescription medications and medical supplies. Drones can rise to fill part of this void. CVS Pharmacy is exploring these options in rural, as well as suburban and urban, markets. Moreover, medication delivery by sustainable UAVs saves time and provides consumers with convenience.

While questions about safety, privacy, intrusiveness, theft, medication exposure, noise, and light pollution remain, there are still significant regulatory hurdles to overcome before drone delivery becomes commonplace. Drones require aviation regulation similar to commercial airplanes. In September 2019, UPS became the first company to receive full Part 135 Standard Certification by the Federal Aviation Authority (FAA) granting UPS its highest certification. This allows the carriers to fly at night and out of operator’s line of sight, to fly as many drones supported by as many operators as needed to meet customer demand, and to collect payment for drone deliveries. In April 2019, Wing received a similar but more restrictive certificate limiting it to a single pilot allowing it to only complete one flight at a time. The FAA guidelines to inform how UAVs will operate in US airspace are anticipated in 2021.

The ascent of “The Airborne Pharmacy” is an inflection point in the delivery of medications to consumers and provides an aerial glimpse of its mainstream future. When imagining that future, the sky’s the limit for real-world, everyday life applications of drone-centric technology. What originated as a part of military infrastructure can now change how life-saving medications reach patients at home or in the inpatient and outpatient settings. “Drone-to-Door” not only has the potential to reshape how medications are delivered but also to transform the consumer experience by providing convenience in an on-demand healthcare economy.

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

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

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

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

For healthcare providers, prior authorization (PA) via fax or telephone is the second most costly medical administrative function. On average, medical staff spend two business days per week on PA. Automating PA while maintaining clinical excellence is essential for better care delivery. With a focus on leveraging digital solutions and fostering data-enabled decisions, Magellan Healthcare is building more provider-friendly approaches to improve care.

Recently Magellan announced a collaboration with Stanson Health, Premier, Inc.’s clinical decision support (CDS) technology division, to deploy DecisionPoint, an industry-leading automated PA solution. Powered by Premier’s CDS technology, DecisionPoint is available at the point of care and supports true automation within the electronic health record (EHR) and the physician workflow, making the PA process easier and more efficient for providers, patients and health plans.

DecisionPoint is built with Magellan Healthcare’s Advanced Imaging Management program clinical guidelines and Premier’s award-winning technology platform. Magellan maintains one of the industry’s most comprehensive evidence-based sets of clinical guidelines. Our clinicians develop our criteria through an extensive process of innovation and refinement. We base these guidelines on the analysis of public, peer-reviewed articles; health plan medical policies; the Centers for Medicare & Medicaid Services (CMS) policies; specialty physician reviews, professional society guideline statements; and other rigorous reviews of scientific documents. We continually monitor peer-reviewed literature, professional society guideline statements, and CMS-covered criteria to update our guidelines regularly, no less than annually. Initially, DecisionPoint will include our suite of the 20 highest-volume advanced imaging studies that make up 85% of all requests.

Working directly in the EHR, DecisionPoint guides provider decisions in real time in response to key workflow events, such as ordering an advanced imaging study. Integrating within the EHR improves efficiency while ensuring safety and quality and reducing undesirable variation in care.

Rules-based programming leverages EHR data, locating all relevant patient clinical information and citing appropriate Magellan clinical guidelines. Requests that satisfy the clinical guidelines are automatically approved and posted in the EHR, and approval IDs are automatically loaded to the record. With a confirmed authorization determination, the member leaves the appointment with a clear plan of action.

Hawai‘i Pacific Health (HPH), one of the largest healthcare providers in Hawai‘i, is leading the way in automating prior authorization by piloting DecisionPoint to help ensure their patients receive real-time, evidence-based decisions at the point of care whenever possible. Administered through HPH’s Accountable Care Organization (ACO) with over 800 physician members, the pilot leverages Magellan’s clinical guidelines and our full panel of clinical experts. We expect DecisionPoint to be available to additional providers in the fourth quarter of 2019 and include additional specialties and tests in the future.

The healthcare industry is in the midst of a significant paradigm shift as it transitions from a fee-for service model to value-based care. As a technology-augmented service backed by the support of providers, DecisionPoint is designed to minimize the industry’s challenges by fully integrating with EHRs at the point of care to enable faster PA and help deliver on the triple aim—improved quality, reduced cost and improved patient/provider experience.

To learn more about DecisionPoint, click here to go to our website, or email ProviderSolutions@MagellanHealth.com.

Prior authorization (PA) goes by many names—preauthorization, preapproval, advance notification, precertification and preadmission, to name a few. All these terms refer to the utilization management (UM) process used by many U.S. health insurance companies to ensure patients receive the right services, equipment and prescriptions at the right time and place. PA requires healthcare providers to request and obtain approval before rendering certain services, equipment or prescriptions in order to receive insurance reimbursement for those services. Not everything requires PA. Typically, authorization is needed for more complex services such as hospital admissions, diagnostic tests, medical equipment and complex prescription medications.

The PA process is intended to act as a safety and cost-saving measure. It can lower costs to the patient, prevent unnecessary or invasive procedures, and reduce the use of unnecessary tests that may expose patients to potentially harmful radiation and/or undue stress. For example, up to half of advanced imaging procedures ordered fail to provide information that improves patients’ welfare.[i] In addition, despite studies demonstrating overuse, rates of advanced imaging procedures continue to rise—increasing costs and exposing consumers to excessive radiation.  Despite its benefits, the prior authorization process needs an upgrade.

According to the 2018 CAQH Index , manual prior authorizations (via fax or telephone) are the second most-costly medical administrative transaction, costing providers $6.61 per submission. Providers estimate their staff members spend up to 30 minutes completing one manual prior authorization. While manual prior authorization is a much-debated topic due to the time and cost it requires, many parties support standardizing and simplifying the process.

Technology can significantly  decrease the need for expensive manual processes.  According to the 2018 CAQH Index, the medical industry could save $417 million annually by transitioning to electronic prior authorizations, which includes $278 million in annual savings for providers and $139 million for health plans.

While many health plans offer web portals to process prior authorizations, this approach requires providers to use different online systems for each health plan. Instead, digital solutions should include automation within the electronic health record (EHR) and the physician’s workflow. Automation is essential to reducing inefficiencies for providers and health plans and enabling authorizations at the point of care while maintaining clinical integrity.

The goal is to make the right decision for each patient—quickly and easily so patients get the care they truly need. Automating prior authorizations will benefit everyone involved.

[i]Beachy, D. (2014, September 8). Defensive medicine driving up wasteful imaging. Retrieved from https://www.healthimaging.com/topics/healthcare-economics-policy/defensive-medicine-driving-wasteful-imaging.