We live in a fast paced, on-demand world, one in which information is available to patients through multiple channels on any medical topic. So, how do you help your patients navigate all the information and working with them, determine what is right for them and their loved ones? How do you help patients understand a diagnosis or a medical condition that needs to be effectively managed?

Care management is a solution that is intended to improve patient care and reduce the need for medical services by helping patients effectively navigate their own health condition. These programs have become a vital tool for organizations in order to meet the needs of their patients while also effectively improving quality and reducing the cost of care. Care Management can be provided by various types of clinical professionals, such as nurses, social workers, and pharmacists.

A successful care management program should include an integrated suite of services such as:

1. Care Coordination: Coordinating with the patient’s physician on assessments, care planning, and interventions.
2. Patient Engagement: Identifying opportunities for patients and developing a care plan that is supported through educational tools and resources to help them achieve their healthcare goals.
3. Health and Wellness: Helping patients make positive and lasting changes to their health through establishing healthy habits and setting achievable goals.
4. Advanced Digital Tools: Providing patients with the convenience and ease of managing their health through digital applications.
5. Data Analytics: Identifying members at risk for non-adherence or in need of care management through data-led and evidence-based algorithms.

A care management solution should be a comprehensive system that offers a suite of products to help patients navigate their health journey. Our MRx Navigate program is one such program that offers a medical management solution for customers and patients. MRx Navigate integrates data-driven, population health, and personalized intervention that leads patients to healthy, more vibrant lives. To learn more about MRx Navigate, click here.

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.

Note: This article originally appeared on LinkedIn, you can read it there by clicking here.

You cannot escape the responsibility of tomorrow by evading it today – Abraham Lincoln

On one of my many cross-country flights, I started to think about how the concept of employment has changed dramatically over the course of my thirty-year career in the US. In this time, information technology and globalization have changed how business is done, increased competition and improved workforce productivity in every industry. These forces have dramatically changed the employer-employee compact*, doing away with stable jobs, lifetime employment, pensions, and predictable career advancement. These have been replaced by a dynamic, ever changing, ever evolving workplace. It’s not a stretch to say the Future of Work is very different, it is emerging and changing right in front of our eyes, and it requires:

• New skills: Students going through school will very likely be in a job that hasn’t been invented yet and more than a third of the job skills that will be needed in 2020 are not considered crucial to the jobs of today
• Curiosity and Continuous learning: These same students are learning core curriculum content that will be out of date by the time they graduate. They need to develop the capabilities to make learning a life-long activity that they enjoy
• Resiliency and Adaptability: Provide the skills required to adapt to careers that have 10-12 job changes in their career and possibly change their career 3 or 4 times, and
• New models of employment: Many individuals with specialized skills will see their career as a series of “Tours of duty”, with a newly defined Employer-Employee compact*. Other employees will expect the flexibility to have more than one gig at the same time enabled by the Gig Economy.

The Workforce of the future is made up of tech savvy digital natives who are always on and always connected. They flow between work activities, personal tasks and gigs that fulfill their need for artistic, financial, security or other needs. These employees are highly adaptable continuous learners, who have a breadth of skills across multiple domains. Organizations need to have a different view of their workforce and talent. They need to plan for employees who:

• Seek a higher purpose and “meaning” to the work they do and balancing that with what they are good at and at the same time enjoying what they do (The Japanese call the “ikigai”)
• Want to pursue multiple jobs/roles/gigs that align with their values and needs
• Prefer to work from anywhere, at anytime through different modalities – work from home, co-working spaces, all-inclusive campuses or traditional workplaces
• Look for the work to come to them as opposed to moving their families to where the work is and spending several unproductive hours commuting in big cities. The nature of work today is increasingly digital, distributed and not constrained by geographical boundaries, it goes to where the skills are
• See work and life as two sides of the same coin. These employees go beyond traditional notions of work-life balance and embrace work-life flow where they work where they want and can handle their personal life when they need to.

At Magellan Health, we believe that communication, collaboration and community are core basic human needs. We believe that collaboration is a highly personal and uniquely human experience that is critical for us to achieve our Massive Transformative Purpose (MTP) of “Leading humanity to healthy, vibrant lives”. Our challenge was to see how we could build a collaboration platform that took advantage of the strengths of this workforce and addressed some of the opportunities and constraints that come with the workforce of the future.

In late 2016, we introduced Magellan Hub, our platform to enable the workforce of the future and make them thrive in the Fourth Industrial Revolution (4IR). Magellan Hub was designed with five foundational principles:

1. It had to be humanized, personal and democratic – the platform needed to be personal in a way that it gave every individual within the organization a unique voice that was their own. It also needed to be representative, self-governing and participatory (collaboration is not a spectator sport). It also should NOT allow for anonymous participation.
2. It had to support emerging modalities of communication – the platform had to go beyond Web 2.0 technologies to include emerging modes of communication including Groups/Communities, Videos, Group Chats, Video and Audio Conferencing, desktop NLP, and Chatbots
3. It had to bridge distance and time – In other words, it had to retain the context of conversations, the history of events and be searchable. In addition, it had to have the flexibility to support real-time and delayed interactions at the same time
4. It had to be everywhere and nowhere – this allowed people to be always connected when they needed to be and completely disconnected when they wanted to be. This enables both pull and push communications where users could opt-in to the content they wanted to see.
5. It had to be future proof – The platform had to be scalable to support our growth and be accessible from anywhere, at any time over no, low and high-bandwidth connections.

We believe in Magellan Hub, we built a platform that supports the workforce of the future to effectively handle the future of work. Here are a four examples:

• When Dana, a new employee joins Magellan, she is instantly connected to the broader community across Magellan. She has the choice to share what she wants to share, develop her unique voice and influence the dialog of her colleagues, her team or the entire company. She can subscribe to the content she wants to see, groups she wants to join, formal and informal leaders she wants to follow. In other words, Dana immediately becomes part of the Magellan Community the minute she gets an ID to access Magellan Hub
• Steve, a long-term Magellan employee, spends most of his time in infrastructure operations and is focused on his day-to-day tactical tasks. With Magellan Hub, Steve can be part of groups that are focused on the projects he is working on to stay in sync with the rest of his team irrespective of where they reside or work from. He can also join special interest groups around technical domains or social domains (such as Magellan Musicians) to connect with others with similar interests. He does all this on his Android smartphone as he is running personal errands working out of his home office.
• Lara, a highly engaged mid-level executive uses Magellan Hub to do a digital management by walking around to check on the pulse of her team that is spread across 12 states and 3 different time zones. She uses HD Videoconferencing and personal chat/video/audio conferencing through to enable these highly personal and humanized experiences without extensive travel. What’s cool is that Lara can have these humanized, high-touch interactions with her team from her home-office, from the indoor gym as she watches her kids play or from an airport as she waits for her flight to take off
• Jeff, who is a product manager developing our next leading edge Cognitive Behavioral Therapy tool can collaborate real-time with his colleagues and team members from different departments across the company to create, edit, comment on shared product specifications in a secure way. At the same time, he uses a closed and private group to discuss and collaborate on these product specifications and coordinate the development of this product across the company.

At Magellan, we are the employer of the future who is fully committed to continuously exceeding the expectations of the workforce of the future. While we may not be there yet, with Magellan Hub, we provide a collaboration platform for employees so that they can do their best work every single day and they become the change that we want to see.

References and Notes:

* Hoffman, R., Casnocha, B., & Yeh, C. (2013, June). Tours of Duty: The New Employer-Employee Compact. Harvard Business Review.

** World Economic Forum. (January 2016). The future of jobs: Employment, skills and workforce strategy for the fourth industrial revolution. http://www.weforum.org/reports/the-future-of-jobs

*** The name Magellan Hub was selected by our employees through a crowd-sourcing contest that was conducted on the platform

Magellan’s own CTO, Srini Koushik, was recently featured in Forbes Insights, talking about the benefits of videoconferencing and how it is changing the way that we work at Magellan. In the article, Srini discusses how new technology is improving efficiency while increasing connectedness and effectiveness of teams.

Check Srini’s profile here.

Earlier this year, Srini shared his experiences reimagining Magellan as a digital healthcare company here on the Magellan Health Insights blog. Take a look at his views here.

The past decade has seen some remarkable changes in technology, which has ushered in an era where we are always “on,” always connected and where most everything that was analog now is digital. Many of us walk around with powerful computers in our pockets –also known as smartphones–that are more powerful than the computers that help put a man on the moon only a few decades ago. Today, we can order car rides from our phones, pay for our groceries, watch movies or do just about anything from a smartphone or network-connected device from anywhere across the globe. Yet for many of us, we go through a time warp when we move from our personal lives to our work environments.

Magellan: a Digital Healthcare Company

At Magellan, we have an inspired leadership team that is building a workforce of the future. We recruit the best talent wherever we can find it across the globe and provide them with great work-life integration by providing flexible working arrangements. Over 40 percent of our workforce does not work in one of our offices, and many of our employees are mobile and on the road helping our member and providers. This kind of a workforce requires the collaboration platform of the future.

During the summer of 2016, we assembled and rolled out Magellan’s next generation collaboration platform. This platform was built with a mobile-first, cloud-first, always digital mindset designed to provide secure, seamless and context-aware experiences within the enterprise. This new platform is all about providing choices: it works across Macs and PCs, across browsers, across Apple and Android mobile devices and can work across a 4G connection and high-speed wifi alike.

The platform uses five technologies that we use in our personal lives on a daily basis:

• Workplace and Workchat for desktop and mobile devices. These are the enterprise- grade versions of Facebook and Facebook Messenger, complete with networking, group collaboration and social sharing capabilities.
• A cloud-based document and content management solution from Box.
• Enterprise-quality HD video conferencing and desktop sharing through Zoom.
• Productivity applications from Microsoft through Office 365.
• An integrated access portal tied together by a robust security and identity management solution from Okta.

Okta acts as a gateway to every other application, website or solution provided by Magellan. It simplifies password management and provides secure multi-factor authentication – in short it makes our applications accessible to everyone, anywhere, at any time over any network or device. It allows an employee to take a video call from her home office and collaborate with her colleagues in a Workplace group and continue that conversation on a mobile device as she takes the train into see a customer for an afternoon meeting – secure, seamless and context-aware collaboration.

 Technology leading culture; culture leading technology

One of the interesting developments in our culture is the use of desktop and mobile video conferencing which allows us to personalize each call, read body language and emotions and share the true benefits of face-to-face communications, instead of being on nameless, faceless, monotonous conference calls.  This is changing the cultural fabric of Magellan by making the enterprise more personal and more social.  It is challenging our management orthodoxies and help reinvent management.

With this new platform, we are building communities that span geographies, business units, departments and even companies. In the past year, we have seen over 700 groups evolve organically on this platform.  Some of these groups focus on specific projects, initiatives or events, and others focus on communities of users and social groups. We even have a community of musicians at Magellan. In short, the platform helps people stay connected in a personal way without having to be located in the same spot.

Ultimately, our technology is a means by which we can help improve the experience – and quality of care – for our customers and members. Our objective for this new platform is to make the technology invisible to the user and allow them to seamlessly play their part to help individuals live healthy, vibrant lives.

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

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

First and foremost, teamwork.

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

Second, and also very important, user feedback.

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

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

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