By Dr. Beall-Wilkins and Dr. Jamie Hanna

Magellan Health hosted a free webinar for September Suicide Prevention Awareness Month. If your question wasn’t answered during the webinar, or if you would just like to learn more about suicide prevention, read on for information shared by our webinar presenters, Dr. Rakel Beall-Wilkins, MD, MPH, and Dr. Jamie Hanna, MD. For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

Question: Please say more about the interplay between chronic pain and suicide risk.

Dr. Beall-Wilkins: It is estimated that the prevalence of suicidal ideation is roughly three times greater in people living with chronic pain compared to those who do not have chronic pain, and chronic pain is linked to higher rates of not only suicidal ideation but also suicide attempts and completed suicides.[1] When coupled with impaired functionality and disability, chronic pain can result in socioeconomic hardships and limitations in access to care that further exacerbate both physical and mental health symptoms. Chronic pain and depression often go hand-in-hand, and clinical studies have shown that upwards of 85% of people with chronic pain have experienced severe depression.[2] It is essential that patients with chronic pain be routinely screened for psychiatric symptoms and acute safety concerns, and that they be referred to treatment if issues arise.

Question: Is a person really considered suicidal if they have considered it a lot but have never acted on their thoughts? What measures can we put in place for individuals with a baseline of passive suicidal ideation who are in outpatient therapy?

Dr. Hanna: Understanding the risk factors that can lead to suicidal behavior provides an opportunity to identify and support people at risk for suicide. Risk factors include a previous suicide attempt, diagnosis of mental illness/substance use, isolation, social/legal problems, trauma in childhood, a family history of suicide, recent stressors and access to lethal means. Learn more about suicide risk and protective factors from the American Foundation for Suicide Prevention and the Centers for Disease Control and Prevention. Suicidal ideation – or thoughts about suicide – is also an important risk factor and can be a warning sign of imminent suicidal behavior. There is greater risk when suicidal thoughts occur more often, over greater time periods or are more challenging to control; there are fewer barriers to acting on the thoughts; and the reason for the suicidal thoughts is to stop the pain. Identifying suicidal ideation and implementing treatment strategies are critical in preventing suicide.

It is always the goal to treat suicidality in the least restrictive setting and subsequently, treatment of suicidal ideation often occurs in the outpatient setting. There are a variety of measures that can be put in place to assess and treat suicidal thoughts in the outpatient setting. Some of these include screening, crisis intervention, and evidence-based and research-informed interventions.

One example of a screening tool is the Columbia-Suicide Severity Rating Scale (C-SSRS). This scale focuses on evidence-based metrics to assess the severity of suicidal ideation and behavior. Items on the scale also serve to differentiate between suicidal and non-suicidal self-injurious behavior.

Crisis intervention assistance is typically provided by connecting a person in crisis to trained staff for support and referral to additional services. The goal is to impact key risk factors for suicide, including depression and hopelessness, increase future mental healthcare access, and put space and time in between suicidal thoughts and action. Examples of crisis intervention services include the National Suicide Prevention Lifeline (1-800-273-8255) and Crisis Text Line (text HOME to 741741).

There are only a small number of evidence-based treatment interventions directly targeting suicide risk. These include cognitive behavioral therapy for suicide prevention (CBT-SP), dialectical behavior therapy (DBT) and Collaborative Assessment and Management of Suicidality (CAMS). Additional research-informed interventions include collaborative safety planning and reducing access to lethal means. These interventions are emphasized in both the CDC suicide prevention strategy and the Zero Suicide approach to suicide prevention.

Question: What do you say to someone who says they want to die and that life is torture, and asks why they were born? What types of things can you tell the person going through this, and how do you do it without sounding judgmental?

Dr. Beall-Wilkins: Feelings of despair, hopelessness, worthlessness and helplessness are commonly experienced by people who are in the midst of a mental health crisis. During episodes of emotional distress, it can be very difficult for some people to think positively or constructively, and this can manifest itself in the form of self-deprecating statements and thoughts of self-harm. When someone is feeling this way, it can be helpful to reassure them that things can get better, and that comprehensive treatment can improve how they feel. It’s also very important to assess their safety, inquire about any thoughts they may be having of hurting themselves or someone else, and encourage them to seek immediate professional help if they’re feeling unsafe.

Question: I had a family member take her life on 9/7. She went about her day as normal, and then chose to take her life that evening after placing her kids down for the night. As a family member, we are still trying to figure out why. Is this a normal feeling? Similarly, for people attempting to support those with suicidal thoughts, or who have tried to support someone who died by suicide, what suggestions do you have to help them find the balance between supporting the suicidal individual and feeling overly responsible for the suicidal individual’s choices, behaviors, etc.?

Dr. Hanna: When a loved one dies by suicide, intense emotions – such as disbelief, anger, guilt, isolation and despair – can become overwhelming, and there is no right or wrong way to feel. Many people will feel confused as they try to understand why their loved one chose suicide. And it is likely there will always be unanswered questions. The events which lead to suicide are often complex and most commonly there are many factors that contribute to a person ending their life.

The feeling of guilt can lead suicide survivors to blame themselves for the death of their loved one. It is critical that survivors do not blame themselves, and that they seek support and engage in self-care. Support and self-care can include reaching out to community members, such as friends, family, co-workers and mental health providers. Both in-person and online support groups are available specifically for suicide survivors. The American Foundation for Suicide Prevention provides resources to find a support group. It can also be beneficial to seek professional help with a licensed therapist or psychiatrist, especially for symptoms of depression and thoughts of suicide.

Question: The hardest part about helping someone who is suicidal is the concern that the police will be called, and the person will end up in handcuffs. How can we change this?

Dr. Beall-Wilkins: It is often the case that family and friends of those who are experiencing acute mental health crises face the prospect of summoning law enforcement to assist in maintaining safety and facilitating transportation to care. This can be a very daunting prospect and a growing movement of advocates, policymakers and mental health providers are now pushing for reforms that would reduce the likelihood of adverse outcomes in these circumstances.[3] One such reform involves greater collaboration between police departments and mental health clinicians, including training, education and joint response to crisis calls. Preliminary data indicate this approach can be a very effective means of reducing adverse outcomes, increasing public safety and strengthening trust within communities.[4]

Question: Is being suicidal hereditary? Are the mental/emotional issues that caused a previous suicide in a family hereditary?

Dr. Hanna: There is clear evidence that suicide can run in families, and family history of suicide has been identified as a significant risk factor for suicide. Studies show that individuals who have a parent or sibling die by suicide are two and a half times more likely to die by suicide than those without a family history of suicide. Research has identified a number of genes that appear to be associated with suicide risk. Psychiatric illness has also been shown to run in families and is a risk factor for suicide. Depression plays a role in over half of all suicide attempts. Children of parents with depression are three times as likely to develop major depression, anxiety disorders and substance use – all of which increase the risk of suicide.

While family history of suicide and psychiatric illness are important risk factors of suicide, other risk factors include previous suicide attempts, depression, substance use, stressful life events, physical illness and access to lethal means, among others. Suicide occurs as a result of many interacting genetic and environmental factors. Family members share genes, and they often share experiences – they eat together, live together and face economic stressors and loss together. These shared experiences may combine with genetics to increase an individual’s vulnerability to suicide. This does not mean that everyone with a family history and increased risk of suicide will have suicidal behavior, but that they could be more vulnerable and should take steps to reduce their risk. These may include early evaluation and treatment of mental illness and building protective factors to buffer against suicidal behavior.

Question: Could you speak to the legalities of those who need help but are past the age of responsibility, and family members and friends are told there is nothing they can do if the person refuses the help or that we can’t keep them somewhere against their will?

Dr. Beall-Wilkins: In most jurisdictions, the ability to commit an individual to treatment against their will is typically conferred by the courts based upon three guiding principles: harm to self, harm to others and evidence of significant mental deterioration that renders an individual unable to practice self-care in their own best interest. If an adult person is explicitly stating an intention to hurt themselves or others, or exhibiting grave mental disability, they can be involuntarily committed for observation, evaluation and acute stabilization.

Rakel Beall-Wilkins, MD, MPH, served as a medical director for Magellan Healthcare. Prior to joining Magellan in 2018, Dr. Beall-Wilkins assisted in the launch of an addiction psychiatry clinic embedded within Harris Health System’s Healthcare for the Homeless Program, to combat local impacts of the nationwide opioid and synthetic cannabinoid (“K2”) epidemics. Dr. Beall-Wilkins also served as a member of the Baylor College of Medicine faculty with clinical duties at both the Ben Taub General Hospital Psychiatric Emergency Center and the Thomas Street Health Center. There she helped to expand behavioral health services by launching a neurocognitive clinic collaborative to better screen, diagnose and treat individuals with HIV/AIDS-associated neurocognitive disorder and psychiatric comorbidities. She is a graduate of the University of Texas at Austin and the Johns Hopkins School of Public Health, where she obtained a Master of Public Health degree. She obtained her medical degree from Baylor College of Medicine. 

Jamie Hanna, MD, serves as the medical director for the Magellan of Louisiana Coordinated System of Care (CSoC) program. She is board certified in Psychiatry and Child and Adolescent Psychiatry. Prior to joining Magellan in 2020, Dr. Hanna served as an assistant professor and assistant training director with Louisiana State University School of Medicine, working with the acute behavioral health unit, and leading the psychiatric consultation liaison service and emergency psychiatric services at Children’s Hospital of New Orleans. Dr. Hanna completed medical school at the University of Alabama School of Medicine and a subsequent internship in Pediatrics, residency in General Psychiatry, fellowship in Child and Adolescent psychiatry, and fellowship in Infant Mental Health with Louisiana State University in New Orleans.

For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

[1] Pergolizzi JV (2018) The risk of suicide in chronic pain patients. Nurs Palliat Care 3: doi: 10.15761/NPC.1000189.

[2] Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural plasticity, 2017, 9724371. https://doi.org/10.1155/2017/9724371

[3] https://www.npr.org/2020/09/18/913229469/mental-health-and-police-violence-how-crisis-intervention-teams-are-failing

[4] https://www.apa.org/monitor/2021/07/emergency-responses

October is American Pharmacists Month and an excellent opportunity for us to celebrate all of our Magellan Rx pharmacy heroes that help our members live healthy, vibrant lives! To kick off American Pharmacists Month, we wanted to shine a spotlight on our two pharmacy residents. We will be taking you behind the scenes to find out what got them interested in pharmacy and what they love most about their residency program.

Magellan Rx: Why did you decide you wanted to become a pharmacist?

Shyra Bias, PharmD: I decided at a young age that I wanted to be the drug expert in my family after witnessing a family member suffer from the complications of extremely uncontrolled latent autoimmune diabetes in adults (LADA). My desire to help my family led to a passion to improve many patients’ lives by ensuring that they can receive the medications they need at a cost they can afford.

Alaka’i Montalbo, PharmD: Growing up, I played a lot of sports and was always in the gym. As an athlete, you learn about sports supplements and how they can help you. In high school, I loved diving into the science of supplements. I later learned in life that the “science” of supplements was not backed by clinical data. After having my dreams crushed, I was working in the hospital and one of the nurses asked me if I had ever considered being a pharmacist? She knew I enjoyed talking about supplements and learning how different medications worked in the body. After researching what pharmacists do, I realized this was exactly what I wanted to do, and I have not looked back since.

Magellan Rx: What advice would you give to someone who wants to become a pharmacist?

Shyra Bias, PharmD: Keep your eye on the prize! The road to PharmD is not an easy one, but if you are truly passionate about the profession, you will get through it. Also, pharmacy is a very small world, so be intentional about making connections because you never know who may be able to change the trajectory of your career.

Alaka’i Montalbo, PharmD: Find joy in your journey. While pharmacy school is a long journey, it will fly by in the grand scheme of life. Don’t give up and never stop believing that you can do it. Don’t fall into the trap of saying to yourself I’m not ready yet. Right now, start making connections with pharmacists and current pharmacy students.

Magellan Rx: What different career paths can you do as a PharmD?

Shyra Bias, PharmD: There are many options for Pharmacists; many do not come to mind immediately when someone thinks of the traditional roles of a pharmacist. Some of the first paths that come to my mind include industry pharmacy, nuclear pharmacy, managed care pharmacy, and clinical pharmacy (hospital setting) to name a few.

Alaka’i Montalbo, PharmD: During pharmacy school, I had the opportunity to go to local high schools and talk about the profession of pharmacy. There are so many different careers Pharmacists can choose and every route is unique. There are traditional roles like retail, hospital pharmacy, and then some non-traditional roles are academia, nuclear (chemotherapy) pharmacy, FDA pharmacists, and Indian health services.

Magellan Rx: What made you choose managed care pharmacy?

Shyra Bias, PharmD: I chose managed care because I really enjoy the population health aspect of the industry. It gives me a true feeling of gratitude to change millions of lives with “the click of a button.”

Alaka’i Montalbo, PharmD: Managed care is the perfect balance between using clinical data and real-world efficacy to help patients manage their disease states. One of my favorite quotes about pharmacy is from Everett Koop, “Drugs don’t work in patients who don’t take them.” I would add to this quote, also with patients who can’t afford them. Managed care is that perfect bridge between both worlds of pharmacy, and I feel like I am making a huge difference every day, not just for one patient but for entire populations.

Magellan Rx: How do you like your residency at Magellan Rx?

Shyra Bias, PharmD: I am grateful beyond words to have been matched with Magellan Rx. The company culture makes me feel extremely welcomed, and the variety of experiences that we are exposed to through our rotations will allow us to succeed no matter where I end up in the managed care industry.

Alaka’i Montalbo, PharmD: Being Native Hawaiian, Ohana (family) means everything to me, and family means no one gets left behind or forgotten. Magellan Rx is one big Ohana and every day, I get to stand on the shoulders of giants. I feel so blessed to be a part of this company and everyone in this residency program is always willing to stop what they are doing, take time out of their busy schedules to help me grow! I cannot express my gratitude enough and I look forward to paying it forward in my career.

Don’t forget to follow us on LinkedIn and Twitter where we will be featuring different pharmacists and pharmacy techs throughout October. #MRxAmericanPharmacistMonth

By Caroline Bohn, R.N., Senior Care Manager, Magellan Behavioral Health of Pennsylvania

Millions of Americans suffer with chronic pain issues, every day of their lives. Conditions such as migraines, back injuries, fibromyalgia, or neuropathy, for example, can cause serious, ongoing pain. Ongoing chronic pain can be a debilitating problem for those suffering with it. Dealing with a chronic pain issue can lead to additional problems, such as a loss of pleasure in life, inability to work, poor sleep or depression. People often seek treatment for chronic pain, to be able to live a better life.

We live in a fast-paced world where we can access just about anything, 24 hours a day, 7 days a week. We can shop and order things on the internet at any time of the day or night, or even go to stores that are open 24/7. No longer must we wait for someone to get home and check an answering machine to receive our messages because we can reach out to others in an instant via cell phones, email, texting, and instant messaging. Going to the movie theatre or buying a DVD in the store are almost obsolete. The limitless availability of television and internet streaming services allow us to watch our favorite shows and movies at any time. The ability to get so many needs met instantly, leads us to expect this type of immediate fix for everything in our lives, including medical issues.

It is understandable that people desire immediate relief from pain, and there are many ways in which pain can be treated successfully and alleviated. One option, which people often choose, is the use of prescription pain medication. But the natural desire to relieve pain immediately can cause people to opt for taking pain medication before trying less invasive alternatives. There are many options for treating chronic pain without prescription medication. For example, interventions such as physical or occupational therapy, transcutaneous electrical nerve stimulation (TENS), acupuncture, biofeedback, or cold laser therapy. Wearing supportive braces or orthotics can be helpful with eliminating pressure on inflamed areas. Yoga, weight loss, and therapeutic massage can aide in reducing muscle and joint pain. Mind-body techniques are also effective methods to address pain, such as meditation, mindfulness, progressive muscle relaxation, and deep breathing exercises. To clarify, the use of prescription pain medication is not an inappropriate choice, but it is wise to explore other options as well. Pain itself, is not a disease. Pain is a symptom or signal used to alert us that something is going wrong within the body. Use of medications to eliminate the pain signal, is not helping fix the problem that is causing the pain. The first step to solving a pain issue is to identify and address what is causing the pain so you do not have to experience pain in the first place. There are situations where it is not possible to eliminate the source of the pain completely, but in cases like these, there could be treatments available to lessen the severity of the pain, so it is manageable with less medication or without the use of medication at all.

Regular use of prescription medication to alleviate pain could cause other issues to arise, even when a medication is appropriately prescribed by a physician and taken according to the physician’s orders. Unfortunately, it is possible for your body to become dependent on certain types of prescription pain medication. Dependence on pain medication is evident when an individual experiences symptoms of withdrawal when taking less of the medication or stopping it altogether. If a person feels they must continue taking pain medication to avoid experiencing withdrawal when not taking it, this could indicate that their body has become dependent on it. If this occurs, a consultation with your physician to discuss next steps is essential.

There are different classes, or types, of pain medications which can be prescribed by your physician. One of these types, called opioids, has a greater risk for dependence than other types of prescription pain medication. If your body becomes dependent on opioid pain medication, it can be difficult to stop taking it. Opioid pain medications have a higher risk for causing withdrawal symptoms when discontinued than other types of pain medication. People could experience nausea, vomiting, sweating, feeling excessively hot or cold, or muscle aches throughout their body, when taking less of or stopping the opioid pain medication. If this were to happen, alerting your physician is crucial. Your physician can assist you with safely discontinuing an opioid pain medication, so you do not have any withdrawal symptoms. If you do not feel comfortable telling your physician you may be dependent on opioid pain medication, there are other ways to seek help. If you have access to the internet, you can visit the SAMHSA website (https://www.samhsa.gov/find-treatment) to get education and information about seeking help with opioid pain medication dependence. If you do not have access to the internet, SAMHSA offer a toll-free helpline as well (SAMHSA’s National Helpline: 1-800-662-HELP (4357).

There is nothing wrong with seeking help when your health is at stake. Reaching out to a trusted family member or friend, to ask for their help, is also a great way to start on the road to your recovery. Above all, it is important to remember that maintaining your physical health and well-being, is crucial to living your best life.

Behavioral health is an important indicator of a society’s overall wellbeing, as it interacts closely with physical health. Unfortunately, most individuals do not receive the behavioral health treatment they need. Fear of treatment, shame, and embarrassment keep many from seeking care. More than one-third of Americans live in areas lacking mental health professionals.[1] Fifty percent of individuals who receive a behavioral health referral do not follow through or have only one visit.[2] Collaborative care addresses these problems by providing physical and behavioral health care in the primary care setting.

What is collaborative care?

Collaborative care is a specific type of integrated care developed at the University of Washington’s AIM Center that treats common mental health conditions, such as depression and anxiety, that require systematic follow-up due to their persistence. Based on principles of effective treatment of chronic illness, collaborative care focuses on defined patient populations tracked in a registry, measurement-based practices, and treatment to target. Trained primary care providers and embedded behavioral health professionals provide evidence-based medication or psychosocial treatments, supported by regular psychiatric case consultation and treatment adjustment for patients who do not improve as expected.[3]

Principles of collaborative care

Developed in consultation with a group of national experts in integrated behavioral health care in 2011 with the support of the John A. Hartford Foundation, The Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, and California Healthcare Foundation, five core principles define collaborative care and should inform every aspect of implementation to ensure effective collaborative care is practiced.[4]

• Patient-centered team care—Primary care and behavioral health providers effectively work together using shared care plans that include patient goals. Being able to receive both physical and mental health care in a familiar location provides patients with comfort and reduces duplication of assessments. Increased patient engagement often leads to a better health care experience and improved patient outcomes.
• Population-based care—Care teams share a specific group of patients that are included in a registry. The registry is used to track patients and ensure that no one falls through the cracks. Patients who do not show improvement are outreached, and behavioral health specialists offer caseload-focused consultation.
• Measurement-based treatment to target—Each patient’s treatment plan includes personal goals and clinical outcomes that are measured using evidence-based tools, such as the Generalized Anxiety Disorder scale on a routine basis. If patients do not improve as expected, treatments are adjusted until clinical goals are met.
• Evidence-based care—Patients receive treatments with sound research evidence to support their efficacy in the treatment of the target condition, including various evidence-based psychotherapies that have proven effective in primary care, such as problem-solving treatment, behavioral activation, and cognitive behavioral therapy, and medicines.
• Accountable care—Providers are responsible for and receive reimbursement for the quality of care and clinical outcomes, not just the volume of care provided.

Collaborative care has been proven to double the effectiveness of depression care, improve physical function, and reduce health care costs. Magellan Healthcare’s evidence-based Collaborative Care Management product, enabled by NeuroFlow, provides care management and psychiatric consults for primary care patients and augments physical health providers’ staff with Magellan staff to facilitate integrated physical and behavioral healthcare. Learn more here.

[1] https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/

[2] https://aims.uw.edu/collaborative-care

[3] https://aims.uw.edu/collaborative-care

[4] https://aims.uw.edu/collaborative-care

New data from the Centers for Disease Control and Prevention shows that suicide rates have risen to over 30% in the US since 1999.[1] Since COVID-19 began, suicidal ideation in the US has more than doubled, with younger adults, racial/ethnic minorities, essential workers and unpaid adult caregivers experiencing disproportionately worse effects.[2] As suicide has reached crisis-level proportions in our nation, it’s time to recognize suicide as a public health crisis and learn about the warning signs and the skills needed to save a life.

Know the warning signs of suicide

It is hard to tell whether a person is thinking of suicide. Most people who take their own life show one or more warning signs, either through what they say or do.

• Feelings: Expressing hopelessness, talking about suicide or having no reason to live, showing moods such as depression, anxiety, irritability
• Actions: Showing severe/overwhelming pain or distress, using drugs or alcohol, searching for ways to end their life
• Changes: Withdrawing from activities, isolating from friends and family, sleeping more or less
• Threats: Talking about, writing about or making plans to kill themselves
• Situations: Going through stressful situations including loss, change, personal humiliation or difficulties at home, school or with the law

Take action to prevent suicide

Suicide remains the second leading cause of death among Americans between the ages 10 and 34, according to the CDC.[3] It is a major health crisis—and preventable. When someone says they are thinking about suicide or says things that sound as if they are considering suicide, it is important to pay attention and take action. Suicide is often preventable.

• Ask and listen: “Are you thinking about killing yourself?” is not an easy question, however, a study by the National Institute of Mental Health shows considering suicide may reduce rather than increase suicidal thoughts. Be willing to listen and discuss their feelings.
• Keep them safe: Reducing a person’s access to highly lethal objects or places is an important part of suicide prevention. Asking if the at-risk person has a plan and removing access to lethal means can make a difference.
• Get them help: Connect with a trusted family member, friend or mental health professional. Call the National Suicide Prevention Lifeline’s (1-800- 273-TALK (8255)) and the Crisis Text Line’s number (741741). Save these numbers in your phone so they’re there when you need them.
• Stay connected: Staying in touch after a crisis or discharge from care can make a difference. Let them know they matter and you care. Leave a message, send a text or call them.

For more information and helpful resources, visit MagellanHealthcare.com/Prevent-Suicide.

If you are in crisis or considering suicide, or if someone you know is currently in danger, please dial 911 immediately.

[1] https://www.nimh.nih.gov/health/statistics/suicide

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

[3] https://www.nimh.nih.gov/health/statistics/suicide

Creating an accessible and personalized user-friendly digital experience is Lauren Rust’s goal as vice president of digital experience at Magellan Health. Based in Houston, Texas, Lauren aims to make it easier for members to understand their behavioral health and find appropriate care, all while reducing the stigma surrounding mental health. By focusing on the needs of our consumers, Lauren and her team hope to create digital experiences that improve the overall wellbeing of Magellan Healthcare members.

Continue reading to find out more about what Lauren and her team are doing to redefine the digital experience at Magellan Health.

What projects are you currently working on at Magellan Health?

As Magellan Health continues transforming the space of behavioral health, a big aspect of that is reimagining our digital experiences. We’re redefining those experiences and the ecosystem that supports them for our members, employers, and providers. It’s about understanding the needs of our consumers and how we meet those needs. We start by listening to our members and taking the time to understand the member journey. Our undertaking is significant: providing integrated digital experiences that help members understand and address their wellbeing and mental health, access the appropriate care they need, and advance innovative approaches to improving behavioral health more broadly.

Why is Magellan Health the leader in this type of work?

Magellan Health is well primed to accomplish this work for many reasons. The first is that we have a long history of delivering the right quality of care to our members and meeting their mental health needs and helping them achieve wellbeing. We also have a culture that supports innovation and positions members needs at the forefront of our work. Additionally, our organization is mission-driven, and passionate about our members and the role that we play in transforming healthcare.

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

There is tremendous respect and recognition across the individuals and teams that make the work Magellan does every day possible. It’s a very collaborative environment, but also one with clear accountability which enables us to have empowered teams that are eager to take on transformative initiatives.

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

It drives excitement and urgency. It’s pushing innovation and a need to continue to evolve and support the needs of our consumers. All of which is essential to the work we are doing.

What are some goals you have in your position and what are some things you’d like to accomplish in your role at Magellan Health?

The most immediate goal we have is to meet the needs of our members by providing them digital experiences that enable them to find and access the care and resources that they need. To get there we are establishing a clear vision, a roadmap, and identifying the best-in-class experiences and offerings to improve wellbeing and mental health. Additionally, delivering on the needs of our customers and providers through quality digital experiences. We must address the behavioral, physical and pharmacy needs of people through an integrated approach that supports the member through their entire health journey. Equally as important, is the support we give to the providers who care for those members. We’ll accomplish this through high tech applications complemented with high touch clinical solutions based on a collaborative model of care and seamless healthcare ecosystem.

Any other comments you’d like to make?

For me, digital transformation often feels like a lot of experiences being launched to deliver on a larger strategy. I think it’s important that we’re focused on the member journey and that we’re trying to make things accessible, easy to access care, and understanding of your total wellbeing. We are excited to expand on Magellan’s clinical expertise and scale by bringing it to life in the digital experiences we deliver.

• Read more about the digital experience here.

As I started my career with a passion to add value to the healthcare industry, I would never have been able to predict the rapid evolution we are experiencing today. Take, for example, specialty pharmacy. What originated nearly 50 years ago as a treatment solution for just a handful of conditions has grown exponentially into a $250 billion industry now treating hundreds of ultra-rare conditions and orphan diseases. The explosive growth of the specialty pipeline, combined with the high cost and complexity of managing specialty patients (who often have at least one other chronic condition or comorbidity), highlights the need for payers to stay ahead of the trend and deploy targeted, future-focused management strategies for better specialty drug management.

Tracking the Trends

In 2008, there were eight specialty drugs approved by the FDA; compare that to 2020 with 53 total specialty drugs, and half of those approved for medical benefit use. Not only are the number and scope of specialty drugs increasing, but so are costs. So far in 2021, five high-cost therapies have been approved with price tags of $400K to nearly $750K—this is the new normal. As high-cost and potentially life-saving drugs continue to enter the market, it becomes more and more difficult to determine which patients should receive them and how they will be paid for.

In 2012, about one-quarter of total pharmacy spend was attributed to specialty drugs; in 2020, we have reached 50%. When you drill down even more, about half of that spend occurs on the medical benefit. Going deeper, oncology remains the top driver when it comes to overall medical benefit costs as the highest-spend category for the past 11 years—representing nearly 50% of total per-member-per-month spend for the Commercial line of business and over 60% for Medicare.¹ How can employers and payers keep track of these evolving market dynamics?

The Power of Magellan Rx Excellence

At Magellan Rx Management, we have nearly two decades of experience creating flexible solutions that allow our customers to improve patient care, stay ahead of trends, and reduce specialty spend across both the traditional pharmacy and medical benefits. As the original experts in medical pharmacy management, we have a deep understanding of the trends and demonstrate our commitment to advance thought leadership in this space with the annual Magellan Rx Management Medical Pharmacy Trend Report^TM. This Report is a one-of-a-kind resource that highlights key areas of spend and trend across commercial, Medicare, and Medicaid lines of business as well as management strategies for new and emerging therapies.

We also leverage our Expert Clinical Network of more than 175 key opinion leaders (KOLs) across multiple disease states that participate in peer-to-peer discussions and guide recommendations for patients with complex and hard-to-treat conditions. This is especially helpful for payers who lack in-house expertise in ultra-rare and orphan conditions as we work to secure specially matched, unbiased KOLs that are affiliated with major healthcare treatment centers nationwide.

And we don’t shy away from the hard stuff. Our legacy is solving complex pharmacy challenges and meeting the momentum of new developments head-on. In fact, that is what makes us stand apart from other PBMs—our integrated approach and account service model is designed to encourage innovation across clinical, formulary design, distribution channels, and medical pharmacy strategies. These unique solutions are prioritized and intrinsic to the value we bring as a partner.

• Medical Pharmacy Solutions with coordinated management across all sites of service, including utilization management support.
• Formulary Strategies for both traditional and medical pharmacy drugs that connect best-in-class formulary management and value-driven rebate solutions with clinical policies and medical pharmacy programs to manage costs.
• Specialty Pharmacy Distribution that takes a patient-centric, clinical approach to drive adherence and improve outcomes, along with cost avoidance and cost management solutions to reduce total cost of care.
• Condition-specific Programs that deliver better health outcomes and improved CMS STAR ratings.

One example of our devotion to excellence is the work we have done in preparation for the market entrance of oncology biosimilars. We started building the foundation in the autoimmune category and continued to refine our methodology, working hands-on with payers and pharma to create a solution that is not passive but evolves with the dynamic market. As such, our customers were able educate their providers and members prior to the availability of oncology biosimilars. Our impact? We’ve delivered over $40 million in annualized savings for early adopter health plans.

Unlock the Possibilities

I am proud to lead a team of industry experts and thought leaders who inspire me every day to challenge the status quo and add value to this complex area of healthcare spend. I would never have guessed that fifteen years post pharmacy school would have led me to where I am now, but I couldn’t be more grateful. Our team is poised to answer the industry’s toughest questions with thoughtful, clinically-focused solutions—and I’m confident we’re already prepared for the next wave of change. It’s in the spirit of our people to push the industry forward, and I take pride that we have the right experts collaborating with our customers to develop proven programs that drive real results.

Are rising specialty costs a concern? Let’s connect on how we can help solve your unique population’s needs. We’re here for you.

1. Magellan Rx Management Medical Pharmacy Trend Report™, 11^th Edition, © 2021

According to the CDC, 1 in 54[1] children is diagnosed with autism spectrum disorder (ASD), with some states reporting 1 in 32[2] children receiving a diagnosis.¹ One of the most common treatments for ASD is Applied Behavior Analysis (ABA), a therapeutic intervention that helps individuals with autism:

• Improve communication, social, daily living and motor skills
• Maintain positive behaviors
• Transfer skills and behavior from one situation to another

Because ABA is a newer treatment than psychotherapy and other therapies, limited academic literature exists to support providers in effective decision-making for intensity and length of care. In addition, treatment plans are individualized and require extensive monitoring with heavy reliance on caregivers, nearly 50%[3] of whom need help managing emotional and physical stress. This makes it difficult for families to gauge treatment effectiveness and contributes to the rising costs of mandated ASD treatment. In fact, according to the CDC, in addition to medical costs, intensive behavioral interventions for children with autism cost $40,000 to $60,000 per child per year.[4]

A shift from fee-for-service models, in which ABA providers are compensated for each procedure, test, treatment, etc. performed, regardless of whether they lead to better outcomes for the patient, to value-based care models that link payments for the provision of services to the quality of services provided and reward providers for efficiency and effectiveness, can help address these challenges and deliver stronger clinical outcomes when the models:

• Emphasize efficacy—Value-based ABA care models should define benchmarks that determine when the maximum benefit of ABA services has been achieved, measure progress against the benchmarks and empower providers in the decision-making process to ensure that intended outcomes are achieved during ABA treatment and beyond.
• Improve member engagement—It is essential that providers and caregivers work together as a team. By participating in regular discussions with providers on progress trends barriers, and ongoing assessment, caregivers are empowered to understand the overall direction and impact of ABA services and how their active participation in their child’s treatment planning and delivery has a strong impact on outcomes.
• Drive-data-informed decision-making—From the onset of ABA services, behavior analysts should set targets or specific behaviors selected for change based on skills assessments. Progress toward these targets should be monitored, analyzed for trends, and continuously discussed with caregivers. This high-engagement, data-informed process drives decisions on the next steps for ABA services, including whether to continue or slowly reduce the number of therapy hours, and enables providers and caregivers to select and use clinical services that will meet children’s needs.

Visit here to learn about Magellan Healthcare’s value-based collaboration with Invo Healthcare to define standards of care for children with ASD undergoing ABA treatment and improve ABA outcome

[1]https://www.cdc.gov/ncbddd/autism/data.html

[2]https://worldpopulationreview.com/state-rankings/autism-rates-by-state

[3]https://www.workforce.com/news/working-parents-finding-support-for-their-special-needs-children

[4]https://www.autismspeaks.org/financial-resources-autism-help