Haita Makanji, vice president, clinical strategy and innovation supporting the specialty division of Magellan Rx Management, has worked for MRx for nearly 10 years, where she has focused on helping to support payers as they navigate the pharmacy space. Makanji, who is based out of Massachusetts, leads a team of highly trained pharmacists and experts in development and implementation of clinical solutions for customers in various high-cost specialty conditions across both the medical and pharmacy benefits including but not limited to cancer, hemophilia, and rare diseases. Her team focuses on utilization management, dose optimization, care management and technology-based programs for commercial, Medicare and Medicaid patients across the country. Continue reading to learn more about the innovative projects Makanji and her team are working on in the pharmacy space:

What sort of projects are you currently working on?

I’m passionate about working closely with payers and supporting them as they navigate the evolving landscape of new, expensive treatments, while also helping to deliver the highest quality of care to patients. For exceedingly high-cost specialty conditions, our emphasis is always on value through delivering clinical solutions that offer the most appropriate treatment to patients while combating the rising spend payers are facing.

For example, a recent project centers on a one-of-a-kind solution for payers focused on precision medicine in the oncology space, which is the highest-spend category for specialty drugs on the medical benefit for over 10 years. This is an exciting, next-generation pharmacy initiative where we will be combining genomic testing with drug selection for providers who treat cancer patients and meeting a critical need for payers who are looking for more complete solutions on both the medical and pharmacy benefit.

In 2021, we launched a comprehensive high-cost therapy program to provide enhanced utilization management strategies and case management referral for ultra-rare diseases. Payers often struggle to identify specialized experts, either internally or within their network, so our ability to leverage our MRx Expert Clinical Network of more than 175 key opinion leaders who practice various specialties, combined with our team of experts, offers a unique opportunity to support treatment decisions that leads to better health outcomes.

Why is Magellan the best place for these projects?

I’m proud to work for an organization that has a deep understanding of medical and pharmacy trends and a history of pioneering industry-first solutions for specialty drug management. With 17 years of experience in managing specialty conditions, we are unique in the marketplace.  Our customers routinely expand their collaborations with us because we continuously elevate our suite of solutions with innovative and forward-thinking approaches. Our mission is to help patients live healthy, vibrant lives and we accomplish this by ensuring that the right patients receive the right therapies at the right time.

What are your thoughts on the culture here at Magellan? How has that culture impacted your work?

We have a family-oriented culture where we collaborate and have a true understanding and trust of each other. Magellan fosters an environment that encourages open, honest feedback in all teams. Magellan also provides employees with the opportunity to challenge themselves and embrace new opportunities. This is imperative as we innovate and bring new programs to the market.

What exciting trends are you noticing in the healthcare industry? In what direction do you see healthcare going and what lessons are there to learn from other industries that can be applied to healthcare?

I’m energized by how quickly our industry is adapting to new technologies and advancements in the delivery of healthcare. Particularly in digital health solutions with the shift towards value-based care strategies and the pivot to personalized medicine.

The market will need to be laser-focused on providing clinically appropriate, personalized care at the lowest cost for both payers and patients.

One lesson we can take from other industries is the ability to be nimble and flexible. Disruptors in every sector of healthcare are bringing new offerings directly to consumers in the hopes that simplicity and transparency will cultivate consumer loyalty. We can take advantage of the availability of data and deployment of new technologies to respond quickly to changing market dynamics and the needs of our customers and their unique patient populations. While we have a proven track record and hundreds of successful case studies across our suite of solutions, it’s important that we never stop innovating!

In the midst of a national children’s mental health crisis, families are doing the best they can to assess how well their children are coping with increased stressors from the pandemic and figure out what to do if it seems they are having difficulty. Psychotropic medication is among the options to consider when indicated. However, over the years, children and adolescents with behavioral health challenges have generally been prescribed an alarming number of medications. This high prescription rate, paired with questions about the appropriateness of the diagnoses used to justify the drugs’ use, has raised many concerns among families, practitioners, and youth advocates alike. Prescribing medication to treat children’s mental health conditions can be appropriate, but parents, caregivers, and practitioners need to fully understand the risks and monitor their use.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Appropriate Use of Psychotropic Drugs in Children and Adolescents, which highlights evidence-based research on the use of psychotherapeutic agents in children and principles for optimal children’s psychopharmacotherapy practice.

Considerations for treatment with medication for children’s mental health

When families consider medication as an option to treat a child’s mental health condition, Magellan’s monograph offers the following to contemplate:

The practice of evidence-based medicine for children and adolescents requires health professionals and child welfare advocates to engage in a careful assessment of the risks and benefits of using psychopharmacological treatments while addressing serious concerns of over-diagnosis and overtreatment in this vulnerable population. As attention to these issues has grown, a strong undercurrent of anxiety and confusion exists about whether the use of psychotropic agents to remove undesirable impulses and behaviors of children may affect their neurological development, personality, character, and temperament. Suspicions exist that over-diagnosis and overtreatment are driven by a supply-induced demand created by pharmaceutical companies and medical providers.

Addressing the shortage of children’s mental health professionals

Another consideration for parents and families is the shortage of professionals providing specialized mental healthcare services for children. Mental healthcare for children is often initiated at the pediatrician’s office, Magellan’s monograph provides the following insights:

Given the significant national shortage of child psychiatrists, there remains a realistic need to rely on primary care clinicians to perform screenings of children for mental health disorders and treat uncomplicated ADHD, anxiety, or depression. However, the problem of follow-up care and ongoing monitoring of mental health problems in pediatric primary care is a matter that must be addressed.

Principles for optimal use of medication to treat children’s mental health

The American Academy of Child and Adolescent Psychiatry published the Practice Parameter on the Use of Psychotropic Medication in Children and Adolescents to promote the appropriate and safe use of medication to treat children’s mental health by emphasizing the best practice principles that underlie medication prescribing. These principles, as highlighted in the monograph, are as follows:

Principle 1: Before initiating pharmacotherapy, a psychiatric evaluation is completed.

Principle 2: Before initiating pharmacotherapy, a medical history is obtained, and a medical evaluation is considered when appropriate.

Principle 3: The prescriber is advised to communicate with other professionals involved with the child to obtain collateral history and set the stage for monitoring outcomes and side effects during the medication trial.

Principle 4: The prescriber develops a psychosocial and psychopharmacological treatment plan based on the best available evidence.

Principle 5: The prescriber develops a plan to monitor the patient, short and long-term. Clinicians should use standardized, objective measures to measure the efficacy of pharmacologic interventions.

Principle 6: Prescribers should be cautious when implementing a treatment plan that cannot be appropriately monitored.

Principle 7: The prescriber provides feedback about the diagnosis and educates the patient and family regarding the child’s disorder and the treatment and monitoring plan.

Principle 8: The child’s assent and parent’s consent are completed and documented before initiating, and at important points during, medication treatment

Principle 9: The assent and consent discussion is focused on the risks and benefits of the proposed and alternative treatments.

Principle 10: Medication trials are implemented using an adequate dose and for an adequate duration of treatment.

Principle 11: The prescriber reassesses the patient if the child does not respond to the initial medication trial as expected.

Principle 12: The prescriber needs a clear rationale for using medication combinations.

Principle 13: Discontinuing medication in children requires a specific plan.

We encourage you to learn more about medication to treat children’s mental health in the full clinical monograph and Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents, here. Both provide valuable insights and information to support the critical behavioral health needs of our nation’s children.

This article is part two of our discussion about the impacts on mental health and the war in Ukraine. Click here to read our tips for adults. 

Information on the war is continually changing. The youngest viewers, children, are watching and may experience the fear and stress associated with images from the war in Ukraine.

To add to the stress and concern, this global crisis comes on the heels of being exhausted and socially isolated by the pandemic. The following are some tips to help children that are impacted or stressed by the Ukraine situation.

Listen to children. Children hear and see things. This can be especially frightening if they have a parent deployed. It is important not to force them to talk. Find alternative ways to communicate with children such as drawing or playing with toys.

Calm conversation. It is important for parents to be calm when talking to their children about Ukraine. Parents need to be careful not to be the source of a child’s anxiety. Parents are encouraged to check-in and ask their children how they are doing.

Answer children’s questions. Support and acknowledge what your child is saying and their potential fears. Reassure your child but do not make unrealistic promises. Answer questions and help in separating fact from fiction.

Provide support. Do not let children watch the images of violence on television. Children who have experienced trauma may need extra attention. Some children may not want to talk about the event. It is okay if they would rather play or be outside.

Limit exposure to media and social media. Limit the exposure to graphic violence on media. For older children, watch the news with the child and then talk about how the child is reacting to what they are seeing.

Maintain a normal routine. Encourage the daily routines such as homework, sports, activities to continue.

Watch for changes in mood. Some children show their reactions in nonverbal ways. Watch for anger, physical symptoms, mood changes, or withdrawing from usual activities and conversations.

The war in Ukraine is continually changing with updates to the minute within the news cycle and social media. Constantly, there are reports and images flooding our electronic devices with images that are incomprehensible to see. Military families have intense stress as they look at the uncertainties of deployments and the impact on military families. To add to the stress and concern, this global crisis comes on the heels of being exhausted and socially isolated by a two-year pandemic. The following are some tips to take care of your mental health during the Ukraine situation.

Limit your exposure – disconnect from electronics and social media. Although it is important to understand what is happening in the world, it is important not to immerse oneself in the event every moment. Set time limits for yourself regarding how much News or social media you watch or follow.

Recognize that people will have different reactions. People respond and react to tragedy and stress in multiple ways. Personal circumstances, such as deployment, may have different responses than those that are not experiencing deployment.

Talk about it. Do not keep your reactions inside alone. Process your feelings by talking to family, friends, and colleagues about your experience. If the feelings are overwhelming, consider talking to Mental Health Professional that can offer personalized strategies for managing your anxiety about current events.

Engage in activities that provide meaning. Participate in activities that are healthy and you enjoy. Some ideas include exercising, cooking, taking a hike, or playing with a pet.

Engage in meditation and mindfulness. Relaxation, or breathing exercises can improve your state of mind and reduce stress. Taking a few moments just to be present can shift your body’s reaction from a stress response. Try a simple breathing exercise of breathing in for a count of 6 hold for a count of 2 and breathe out for a count of 6.

COVID fatigue. Acknowledge that after a two-year pandemic and many people are tired. The Ukraine situation is especially hard to absorb. It is normal to feel overwhelmed

Avoid catastrophizing. Avoid thinking about future scenarios and what the outcome might be. Focus on one day at a time for now.

Do psilocybin, MDMA, LSD, ketamine, and cannabis sound familiar as medication therapy to help treat mental illness? It goes without saying that the pandemic has intensified mental health symptoms in the United States (US), turning an urgent matter into a crisis. One in 5 American adults suffers from mental illness, with young adults ages 18 to 25 years reporting the highest prevalence. These numbers speak volumes. Some treatment options do not adequately treat patients with mental illness and are associated with significant side effects. This underscores the need for more effective treatments. Because of these factors, psychedelics and other psychoactive substances are gaining momentum as possible alternatives.

Psychedelics are a “mind-manifesting” hallucinogenic class of psychoactive compounds that affect perception. They have been used by ancient civilizations for medicinal purposes and religious rituals for thousands of years. There is a renewed interest in using psychedelics to treat mental disorders driven by global research, influencers, education, and patient voices. Philanthropy has been the main funding source for psychedelics. However, a recent federal grant to Johns Hopkins Medicine to study psilocybin for tobacco addiction may signal a sea change in federal funding of psychedelic research.

While small-scale clinical trials have been promising, for psychedelics to become mainstream, large-scale randomized controlled trials are needed to fully evaluate their safety and efficacy. Studies are underway through several leading centers including MAPS – the Multidisciplinary Association for Psychedelic Studies – a non-profit dedicated to psychedelic research.

Psychedelics are not currently approved as prescription medications. Notably, the US Food and Drug Administration (FDA) has given Breakthrough Therapy designation to two psychedelics – MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD) and psilocybin-assisted therapy for treatment-resistant depression (TRD) and major depressive disorder (MDD). FDA’s Breakthrough Therapy is designed to “expedite the development and review of drugs which may demonstrate substantial improvement over available therapy.” As clinical trials progress, 2023 could bring regulatory approval for the MAPS’ MDMA-assisted psychotherapy for PTSD, a potential turning point in the mental health treatment paradigm.

Patients with mental health illnesses deserve to heal and restore balance to their lives without stigma and judgment and deserve treatments that are safe and efficacious. Step into Magellan’s Clinical Insights for the role of psychedelics in treating mental health conditions. This industry-first paper explores the current evidence, regulatory, and legislative landscape for psychedelics and shares Magellan’s four pillars on emerging therapeutic frontiers. We are guided by four principles:

• Education and thought leadership for patients, payers, providers, and stakeholders while addressing the stigma around mental health
• Evidence-based clinical recommendations and coverage
• Patient safety by advocating for quality standards
• Access that is responsible and sustainable

Disclaimer: The content in this blog article is not a substitute for professional medical advice. For questions regarding any medical condition or if you need medical advice, please contact your healthcare provider.

For Greg Dicharry, his work at Magellan Healthcare is not just a job, it’s a passion. Filming and directing documentaries highlighting suicide awareness has been a welcome side gig of Dicharry’s job as national youth empowerment director at Magellan. For the past 14 years, Dicharry has been connecting with people affected in some way by suicide, substance use and other mental health concerns. From those experiences, he launched the MY LIFE (Magellan Youth Leaders Inspiring Future Empowerment) program. MY LIFE provides various activities and workshops for youths ages 13 to 23-year-olds nationally who have experience with mental health, substance use, juvenile justice or foster care-related issues or have a friend or family member coping with these issues. Dicharry’s latest documentary project, “My Ascension,” shows the crippling effects suicide can have on families while telling the captivating personal story of a suicide survivor. Continue reading to learn more about the MY LIFE program and Dicharry’s upcoming documentary.

What sort of projects are you currently working on?

My main responsibility at Magellan is overseeing our MY LIFE program, which we created in 2008 as part of our Maricopa County, Arizona contract. Since 2008, MY LIFE has been leading the way nationally for youth involved in behavioral health and foster care systems. Through regular meetings, special events, performances, social media, and local and national presentations, youth share their stories and support each other in their recovery goals. In response to the COVID-19 pandemic, Magellan launched the Stay Home for MY LIFE virtual youth fest series in 2020. I also do a lot around suicide prevention for the Company and am a part of the new Suicide Center of Excellence. In my spare time, I create documentaries. Over the last three years I’ve been working on a documentary called “My Ascension.” Prior to that I had done another documentary called “Suicide: The Ripple Effect” but this new one is on teen suicide. I made it with a young lady who is a suicide attempt survivor. She attempted to take her life by gunshot and the result was that she is now paralyzed. She had this rebirth through that and now uses her experience to help others via speaking and advocacy, so the story is largely her story but also of other young people in the community who were successful in their suicide attempts and the aftermath of how that has affected their families.

“My Ascension” will premiere nationally on PBS (Public Broadcasting Service) in September. The primary distribution method has been virtual community screening around the country. We’ve done screenings with a couple of universities and several advocacy and mental health groups.

What inspires you to create these documentaries?

I dabbled in film and media throughout high school and college. When I moved to Los Angeles I started working on projects like movies, award shows, commercials and music videos and learning that way.

With the MY LIFE program, I had gotten a camera through Magellan and was able to start producing videos with the youth group so that got me back into filming and then I met a man through work, who’s a suicide attempt survivor, we became friends and he approached me wanting to make a documentary and I helped him with producing and directing. I didn’t plan on doing another documentary, but the opportunity came to tell this very compelling story for “My Ascension” that could reach a lot of young people and empower them in helping them to share their stories.

I also have a personal connection to this where I’ve found myself struggling with suicidal thoughts, and my cousin who was bipolar with a substance abuse issue and died by suicide about 20 years ago. I saw the impact that had on his family and that inspired me to be interested in the topic.

Why is Magellan the best place to do this project?

Magellan is open to innovation, even though it’s a big company everyone is open to new ideas to help better serve our members and customers. For example, with MY LIFE I came up with the idea to do this, it wasn’t something that was a part of my job description or something Magellan had ever done. But they let me run with it and it was successful. People saw the value of it and saw that the opportunity to serve our members and provide them with something in a different way.

With the documentaries, my job had allowed me to be able to do that kind of stuff on the side and it ended up being another way to connect with people differently way and blend the work I’m doing here.

What are your thoughts on the culture here at Magellan? How has the culture at Magellan impacted your project?

It’s a culture that’s open to innovation and that’s open for doing unique things that are engaging for our customers. It’s very supportive, encouraging, and positive work happening here.

• Learn more about MY LIFE here.

Finding the best strategies to achieve good outcomes is one of the many goals of Tim Daley. As vice president of network development Tim’s two main responsibilities include network optimization and value-based contracting strategies. By working closely with providers to define a high-quality experience for members, Daley aims to create a more efficient member journey that creates excellent outcomes. According to Tim, leveraging Magellan Healthcare’s experience and expertise in behavioral health will help strengthen provider partnerships. Read more below on how Daley manages network optimization and value-based programming:

What are some projects you’re currently working on?

I’m very excited about our work on network optimization. We have a large national network, with members also spread out across the country, which has been developed over decades. It was time to assess our networks in terms of access, availability, quality, and outcomes relative to the varying needs of our members. We currently share actionable insights with providers via our new provider partnerships team. Ultimately, a high performing network that meets the unique needs of individuals will lead to better outcomes and lower overall costs for everyone.

On the value-based programs side, my role is to ensure Magellan designs and implements programs that achieve better results under alternative payment models compared to fee-for-service. Magellan has a long history of partnering with facilities on value-based contracts, and now we’re doing the same with out-patient providers.  For example, a provider may see a patient for 45-minutes, and they want to be paid a certain amount for that session, which could lead to a “the more sessions I do, the more I’ll get paid” mindset. Is that driven by the payment model or is that driven by the best experience for the member? There are several “disruptors” emerging in the behavioral health space, and I’m proud to say I am leading the charge on network inclusion while contracting in ways that ensure provider incentives are aligned with improved outcomes.

Why is Magellan Health the best place to do these projects?

I don’t think there’s anybody out there with more full-spectrum behavioral health experience than Magellan. We’re focused every day on patients having a good outcome, a good experience, and how the care delivery model may require a little more care coordination or engagement at the time of transition.

Implementing true partnerships with our provider community is not just the network team’s role, but a cohesive approach that spans across all departments within Magellan. Therefore, our people, their experiences and commitments to making a difference in people’s lives, are the strongest asset we have as an organization.

What are your thoughts on how the culture is here at Magellan Health?

We’ve gone through a change over the past year with offices closing and a lot of people having to work from home, but I’ve seen almost everyone embrace that change. There’s a real commitment here to what we do. I’ve talked with many other employees who have had their own connection to someone dealing with a behavioral health issue, many of which were exacerbated by the pandemic. So many of us have dealt with a behavioral health experience so we know what a good outcome feels like because we’ve lived through it personally. We need to continue to translate that into what we do day-to-day here.

How does the culture at Magellan Health impact the projects you’re working on?

The personal experience and culture that everyone here brings and the dedication to this work despite challenges help everyone to be driven to do the right thing. We need to continue to move in that direction, tackling the larger issues and prioritizing energy on what makes a difference. If we can do that, then not only will Magellan succeed but patients will truly be the winner.

What direction do you see the healthcare industry going in?

I think behavioral healthcare needs have become more of a focus during and coming out of the pandemic; over the past year it’s become much more of a focus. It really is all about people. Everybody’s got something going on and we must look at the mind and the body one. When you put that together with the physical health side of things, I think we can do well by people.

The Problem

Intimate partner violence is a national public health issue, resulting in devastating personal trauma and effects on our country. Intimate partner violence includes physical violence, non-consensual sexual violence (including non-physical sexual events, such as sexting), stalking, and psychological aggression.

According to the CDC, intimate partner violence in the United States is far more common than we would want to believe, impacting approximately 25% of women and 10% of men¹.

This issue is also prevalent in the military. In 2020, there were 12,663 reports of spouse abuse and 2,026 reports of intimate partner abuse in the U.S. military. Among all military incidents, 63% of active-duty abusers were Non-Commissioned Officer Ranks (E4-E6); when accounting for only those incidents involving spouses, the highest rates of active-duty abusers were among junior enlisted ranks (E1-E3)[1].

The physical and emotional suffering of intimate partner violence victims is profound. What is also clear are the consequences for our Armed Forces. When intimate partner violence involves service members or their families — either as victims or offenders — the resulting trauma harms overall unit readiness.

Prevention Strategies

Collectively, Magellan Federal has over 30 years of experience supporting Family Assistance Programs and positions us as experts in the field. We interact with 30,500 service members and families yearly providing vital services to ease the unique stressors of military life that can aggravate or trigger patterns of abusive behavior within the family home.

Recognize the Risk Factors

Drawing upon our wealth of experience, we believe that if warning signs are recognized and addressed early, intimate partner violence instances can be significantly reduced.

The identifiable factors unique to military service that may aggravate intimate partner violence risks include:

• Frequent permanent change of stations (PCS) disrupts access to natural support networks, increasing stress and social isolation. Frequent moves may also limit the ability of non-military spouses or intimate partners to find and maintain employment, increasing financial reliance on the abuser.
• Frequent or unpredictable deployments and a related increase in domestic duties of the partner may contribute to a sense of instability, increasing relationship stress, or conflict[2].
• Stigma of reporting abuse may lead to the belief that there may be a negative impact on the service member’s career. This may hinder the victim from seeking help for fear of retaliation by the service member and/or loss of financial support and benefits.

Suggested Solutions

The Department of Defense (DoD) offers a foundation of programs, tools, and personnel to promote awareness of intimate partner violence. However, they are often hindered by a lack of uniformity across the military Services and participation is often voluntary, rather than mandatory.

We believe the following will enhance outreach to spouses and intimate partners, with particular focus on those who live off installation and/or may not regularly interact with military life resources.

Key activities to better reach spouses and intimate partners on installation include:

• Expanding FAP communications plan to include the installation level. Updating the DoD-level FAP communications plan to include the military Service and installation levels will better enable FAP officials to gauge spouse awareness needs as well as trend responses longer term.
• Leveraging spouse groups. Every installation, regardless of the specific military Service, should have a spouse club that can be leveraged for outreach.

Key activities to better reach spouses and intimate partners off installation include:

Partnering with other government entities in community outreach. Programs and resources like the New Parent Support Program (NPSP), Domestic Abuse Victim Advocacy program (DAVA), Military & Family Life Counseling (MFLC), and Child & Youth Services (CYS) regularly engage in community outreach and training and, therefore, present an opportunity to increase FAP promotion to off-installation spouses and intimate

• More consistent collaboration between installation-level FAP resources and these programs and resources will serve as a force multiplier.
• Partnering with non-governmental entities. More consistent engagement with local chapters of Non-Government Organizations, such as the American Red Cross, and Military Support Organizations already working in the communities around an installation will better capture off-installation spouses and intimate partners.
• Leveraging non-traditional community resources. Some who live and work off installation may be isolated even from community-facing resources like NPSP and MFLC. Reaching these spouses and intimate partners may require a more creative approach encompassing more “touchpoints” in their day such as leaving education materials at a local daycare, food pantry, thrift store, library, junior league chapter, or church.
• Increased tailoring of outreach strategies to specific populations. The spouses or intimate partners of more junior enlisted personnel may not be in a leadership position to distribute information, so they may just be interested in a more informal meeting with a victim advocate or a pamphlet of FAP resources, rather than a formal briefing. Increased flexibility in outreach strategies will ensure more complete utilization of existing prevention resources.

Key Takeaway

Ultimately, effective prevention strategies must ensure outreach and mitigation activities incorporate all categories of risk factors—individual, relational, community, and societal. The methods to battle intimate partner violence must also ensure all at-risk people (perpetrators and victims alike) receive appropriate education and aid.

We believe prevention is the best opportunity for affordable, high-impact solutions to the needs of our military.

[1] Centers for Disease Control and Prevention. (2021, November 2). Preventing intimate partner violence | violence prevention | Injury Center | CDC. Centers for Disease Control and Prevention. Retrieved December 8, 2021, from https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html.

[2] Kamarck, Kristy N., Ott, Alan, Sacco, Lisa N. (2019, December 4). Military Families and Intimate Partner Violence: Background and Issues for Congress (Report No. R46097). Congressional Research Service. https://crsreports.congress.gov/product/details?prodcode=R46097