Children who are socially withdrawn, shy, and appear to lack self-esteem are more likely than other children to be targets for bullying. Children who appear confident and strong are better able to discourage children from harassing them.

Parents and other important adults in a child’s life can use these suggestions to help boost a child’s self-esteem:

• Encourage your child to participate in extracurricular activities such as sports or drama, which can raise a child’s confidence and sense of mastery. Sports, in particular, also help build strength, which can level the imbalance of physical power between children. Some children may prefer individual sports (such as karate, gymnastics, and swimming) over group sports (such as soccer or baseball). Drama classes can help children project strength and confidence, even if they don’t feel it at first.
• Help children become involved socially with other children through school, church, or community activities. This way, children will build social skills and learn to be at ease with others. Children who have friends and “hang out” with them at school are less likely to be targets for bullying than lonely children who have no social support.
• Role-play with children to show them how to appear confident and how to handle encounters with children who harass them. Help children learn to look people in the eye and to speak with a strong voice—but not shout—when talking to would-be bullies.

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Read the full article here: https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=uf4898

“For a turtle to walk forward, it has to stick its neck out. Because Wraparound challenges systems to support families in unique and strength-based ways, staff must take chances when doing things differently than has been done in the past. Hence, they stick their necks out for change and work toward a better future for children, youth and their families.” – National Wraparound Implementation Center

Our challenge as wraparound providers is to stick our necks out for change! We are all working for a better future for the children, youth and families in Wyoming. Though our roles may differ, the objective is the same. Keep more youth at home, in school and out of trouble.

I have had High Fidelity Wraparound graduates tell me, “You saved our family.” The comments are heartfelt and genuine. But in wraparound, we don’t save their family. We do our duties with respect and fidelity. We show up for families, have hard conversations, reframe thoughts and ideas into action items and create tangible goals. We help them start to build a solid team of “go to” people and supports. We give a lot of suggestions and do a lot of work. But we alone, do not save their families.

They save their family. They do the hard stuff. They listen when they don’t yet understand how things could be different. They show up to their wraparound meetings and start to learn the process. They work to strengthen relationships needed for more natural supports. They are brave enough to question systems and processes that don’t work for them. They try new things, even though they are unsure of the outcome. They trust a stranger, like me, who shows up to help. They believe in me, and I believe in them. They keep on building trust in each other and confidence in their own abilities. They keep doing this work until one day they don’t need me anymore. It’s not as if everything is changed, fixed and all challenges solved. They did grab onto a life preserver when it was thrown. They did all the hard stuff to save themselves. That’s the true work. As wraparound providers, we share in the work load, but it is not all ours to do. Not even close.

Some families that I hear from I have worked with over 10 years ago. I believe this is because we built solid connections which are genuine. I stuck my neck out and let people know how to reach out if they ever need me, even after they transitioned from wraparound. What stands the test of fidelity to the model of wraparound is not how many youths are “saved”, but how many families and individuals we influence to create lasting and positive change in their lives. The relationships we build is what sets the stage for how well the process of wraparound gets incorporated into everyday life. We must be brave and risk our necks at times to build authentic relationships with people. We are all vulnerable. Sticking our necks out for the right reasons, at the right time and in right way, keeps Wyoming’s families moving forward.

Who’s with me? Turtles unite!

More than 400 nationally-recognized payers, physicians, and industry insiders came together to share thoughts and insights on the ever-evolving specialty drug landscape at the 16^th annual 2019 Magellan Rx Management Specialty Summit hosted August 26-28 in New York City.

As the specialty drug trend continues to rise (especially on the medical benefit) and the pipeline continues to expand, focusing on management strategies and solutions is key. With biosimilars flooding the market and capturing the headlines, and looming policy updates creating uncertainty, this year’s event was a platform to tackle these critical topics and the future of our industry.

“We’re honored to be the forum that brings people together to share insights, engage in thoughtful debate, so that we can all walk away with actionable solutions to effectively manage this growing specialty drug trend.” –Steve Cutts, senior vice president & general manager, specialty, Magellan Rx Management

Highlights from this year’s program include:

• Dr. Peter Bach of the Memorial Sloan Kettering Cancer Center reviewed the latest developments for better oncology management and Dr. Rafael Fonseca, a Mayo Clinic Distinguished Investigator, examined applications for a more personalized approach to treatment for complex specialty conditions.
• Magellan Rx chief medical officer Dr. Caroline Carney was joined by Sarah K. Emond, executive vice president and chief operating officer of the Institute for Clinical and Economic Review (ICER), in a fireside chat about ICER’s approach to health policy and excellence in the U.S.
• Mostafa Kamal, CEO of Magellan Rx, led a panel of forward-thinking innovators who are disrupting the status quo by providing tech-based solutions to improve healthcare delivery and outcomes: Raj Agarwal, chief executive officer at Medocity; Adam Hanina, chief executive officer at AiCure; and Richard Waithe, president of VUCA Health.
• Several panel discussions highlighted next-level management strategies around medical pharmacy solutions as well as emerging therapies like CAR-T and other gene therapies to treat rare and orphan diseases, and featured a diverse group of speakers including executives from national and regional payers, pharmaceutical manufacturers, and physicians:
  • Martin Burruano, RPh, Vice President, Pharmacy Services, Independent Health
  • Mona Chitre, PharmD, CGP, Chief Pharmacy Officer & Vice President Clinical Analytics, Strategy & Innovation, Excellus BlueCross BlueShield
  • Kim Dornbrook-Lavender, PharmD, BCPS, Director, Clinical Pharmacy, Medica
  • Pat Gill, RPh, Director of Pharmacy Programs, Horizon BCBCS of NJ
  • Doug Long, Vice President, Industry Relations, IQVIA
  • Joseph Nolan, General Manager – US, AveXis, Inc.
  • Helio Pedro, MD, Clinical Geneticist, Hackensack Meridian Health
  • Carly Rodriguez, PharmD, Pharmacy Director, Clinical Innovation, Moda Health
  • Natalie Tate, PharmD, MBA, BCPS, Vice President, Pharmacy Management, BlueCross BlueShield Tennessee
• Industry experts Claire Wulf Winiarek, Beth Hebert-Silvia (VP & Practice Lead, Health Plans at Pharmaceutical Strategies Group) and Michael McCaughan (founding member of Prevision Policy LLC) shared their insights on the current policy landscape.
• TV personality and author Janice Dean graced the audience with her very own patient story—after receiving a Multiple Sclerosis diagnosis in 2005, she underwent treatment and found hope and a passion for sharing her story to encourage others who are living with MS to live their best lives as well.
• Keynote speaker Keller Rinaudo shared his incredible story of perseverance that led to the launch of a revolutionary healthcare startup, Zipline, that is rapidly changing the face of medicine in remote parts of the world—and future expansion for U.S. disruption.

As pioneers in specialty pharmacy management since 2005, Magellan Rx has been leading the conversation around better management strategies that not only provide cost savings for payers but positively impact patient health outcomes. Each year, we develop the Specialty Summit agenda with those values in mind. Mark your calendars and join us next year in NYC on August 24-26, 2020 as we host another event that will ignite inspiration and innovation across the industry.

Magellan Health Insights: Dr. Ghani, thank you for chatting with us today. Why do you think it’s important to be aware of minority mental health?

 Dr. Shareh Ghani: Many psychological conditions have a connection to the individual’s perception of themselves. How comfortable do we feel in our environment? How well do we fit into what is seen as the norm? It’s human nature to want to fit in. Being a minority myself as an immigrant to the U.S. from Pakistan, I can see that there is extra pressure when you may be uncertain about fitting in or what is expected.

Seeking treatment for mental health unfortunately carries a degree of stigma for everyone and minorities are much less likely to seek or receive treatment for mental health conditions. For those who don’t speak the primary language or do not speak fluently, it can be even more difficult to seek these services and treatment. In addition, there may not be bilingual providers available or covered in the network, if the patient has insurance coverage – which is less likely for minority members. We are starting to see improvements, but for immigrants and members of other minority groups, it can be even more difficult to ask for help.

Magellan Health Insights: Why wouldn’t a minority member seek out care for mental health?

 Dr. Shareh Ghani: There are many reasons. Fundamentally, these members are often challenged by the complications of poverty and social determinants of health (SDOH). Language, i.e. communication and or comprehension, can be a barrier. Beyond language, it may not be culturally acceptable to ask for help. It may seem embarrassing. Which leads us to stigma. The person’s community at large, the clinicians and physicians providing care, and even the patients themselves may see it as stigma. People openly discuss their diabetes but not their depression.

 In addition, these patients are less likely to be routinely screened. They also may not be able to specify that their symptoms are symptoms of a behavioral health condition. In the U.S., patients come to me and say they think they may be depressed. In India, my patients would describe physical symptoms – like gastrointestinal problems. This means they may go through a battery of tests to eliminate physical diseases before behavioral health is addressed.

Magellan Health Insights: How can providers best support minority mental health?

Dr. Shareh Ghani: Paying extra attention and being aware of the cultural needs of every individual is key. In order to come up with a successful treatment plan, providers need to be knowledgeable about cultural factors. And they need to ask about what their patients preferences are related to care. Unless and until we talk to each person about their comfort level working with a provider of a particular gender, someone from their own culture or sexual orientation, or even age group, we can’t provide the best treatment. We, as patients, are most likely to speak openly when we feel comfortable. Being able to speak openly with a therapist or provider will make it more likely that the member will be accurately diagnosed and that treatment will be more successful.

Providing culturally competent care is critical – all care must be culturally competent care. What does that mean? We must be able to provide care to patients with diverse values, beliefs and behaviors and meet patients’ social, cultural and linguistic needs. We must acknowledge the importance of culture, recognize the potential impact of cultural differences, and adapt services to meet culturally unique needs. By taking training and educating ourselves on cultural competence we can reduce the racial and ethnic disparities in healthcare and give all of our members the best care. 

Magellan Health Insights: We couldn’t agree more! Thank you, Dr. Ghani!

Read more about Minority Mental Health Here

With the number of opioid-related overdose deaths in the U.S. reaching a record high last year, it’s time for our nation to fully embrace evidence-based treatment options that best support our communities, loved ones, friends and families in their recovery efforts.

One growing approach—often considered as the gold standard of treatment—is medication-assisted treatment (MAT). MAT is the use of FDA-approved medications in combination with counseling and behavioral therapies to provide a holistic, person-centered approach to the treatment of substance use disorders (SUDs). The use of this treatment approach has grown to nearly 40 percent in residential facilities and is increasingly leveraged by primary care providers nationwide—but more still must be done for widespread adoption.

The most pervasive stigma surrounding MAT is that it merely enables patients to replace one addiction with another. It’s a belief held not only by some groups of doctors and clinicians, but also family members and peer support groups—those whose support is critical to successful recovery. When a patient’s core support system of family members and peers doubts the legitimacy of an evidence-based form of treatment, the likelihood that the patient will follow through long-term is diminished.

Pair that with a lack of understanding and comfort from the medical community around how to administer MAT, limited numbers of physicians who are certified to prescribe this treatment that actually do prescribe the treatment, as well as the number of residential facilities that offer MAT, and we get low adoption rates as a result of these barriers.

There’s a better way to treat opioid use disorder

Although abstinence-based therapy works for a small percentage of those suffering from OUD, MAT offers a successful way for people to fight their addictions in an outpatient environment, in the community in which they live, and avoid hospitalization or institutionalization. It helps those struggling with OUD and other SUDs address underlying conditions that may have contributed to substance abuse—significantly improving the chances of recovery. In one study, more than half of patients utilizing MAT reported opioid abstinence 18 months after beginning treatment.

Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction. And even fewer actually prescribe buprenorphine to patients. MAT prescribing is not limited to psychiatrists. In fact, primary care providers provide more access to MAT than any other type of provider.

The impact of limited access to MAT on health outcomes cannot be overlooked. One analysis found only one-third of individuals who experienced a nonfatal opioid overdose received access to MAT. Those who received methadone were linked to a 59 percent decrease in mortality rates after one year, according to the analysis. Additionally, individuals who were treated with buprenorphine were associated with a 38 percent decrease in mortality after a year.

Increasing Access to MAT

The SUPPORT for Patients and Communities Act, signed in October 2018, expands the ability to prescribe MAT by increasing clinician eligibility for certification. This provision is a solid and necessary step toward broadening access to treatment; however to make a true impact on the opioid epidemic, we must break the stigma surrounding MAT.

When it comes to recovery, the potential for relapse is high, especially in the early stages when resolve is fragile. It is important to note that for individuals with co-occurring mental health conditions, chronic pain or other addictions, MAT should be supplemented by treatment for those conditions, such as cognitive behavioral therapy. Building in care management support to assist in navigating the treatment process may reduce the possibility of relapse and/or readmission to a substance abuse inpatient or residential rehabilitation program. It also helps provide individuals with the tools needed to live addiction-free.

By taking the time to dispel the myths about non-traditional addiction treatment like MAT, we create an environment that more fully supports a return to complete health—physical, mental and emotional. Fighting the stigmas around MAT is an important step toward enabling those suffering from OUD to recover from their addiction and live healthy, vibrant lives.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As we observe National Minority Mental Health Awareness Month, we sat down with Dr. Rakel Beall-Wilkins, a former Magellan Healthcare medical director.

 Magellan Health Insights: Dr. Beall-Wilkins, thank you for speaking with us today. Of course, everyone’s mental health is critical, but why is it important to pay particular attention to the mental health of Black, Indigenous and People of Color (BIPOC)?

Dr. Rakel Beall-Wilkins: We know that mental health conditions can be successfully treated. However, BIPOC are significantly less likely to receive treatment for mental health conditions, including substance use. And it’s reaching crisis levels, especially among our young people. For example, suicide is now the third leading cause of death among African American males who are 15-24 years old.

Magellan Health Insights: What are the barriers to BIPOC receiving high quality mental health treatment?

Dr. Rakel Beall-Wilkins: BIPOC are less likely to seek treatment, both for their physical and mental health. However, when they do reach out for assistance, they are less likely to receive consistent, high-quality treatment.

There are many contributing factors to these barriers. The high costs of care can be a deterrent. Most BIPOC in the U.S. (with the exception of Asians) have higher than average rates of poverty. BIPOC are more likely to lack insurance coverage, and may only seek emergency care, which costs more and is less effective than sustained treatment. Medications or diagnostic procedures may be viewed as too expensive. Or reliable transportation for follow-up care may not be available.

There are also what are called the social determinants of health (SDoH). These include factors such as consistent transportation, the availability of healthy food, safe and affordable housing, access to education, public safety and working conditions. BIPOC are more frequently negatively impacted by the SDoH. For example, these members are more likely to be homeless or move frequently, which interferes with maintaining consistent treatment. They may lack adequate nutrition and are at greater risk for having associated medical conditions like hypertension or diabetes.

Further, the stigma around mental health conditions, while improving, is still a deterrent to seeking treatment—for everyone. Some cultures may see it as taboo to request help or be seen as someone who needs help.

When BIPOC patients do seek treatment, there may be no one available who speaks their language. In some clinical settings I’ve been in, it could take a week to arrange for an interpreter or a therapist who was proficient in the patient’s language. They may not have a primary care physician (PCP) to help with screening for mental health conditions or provide follow-up care. In addition, the community clinics where BIPOC are more likely to receive care may be understaffed, overcrowded and have long wait times. Understaffing may lead to inadequate screening or even misdiagnosis. And, frankly, the clinic also may not be in a place where the member feels safe traveling so, they may hesitate to go in the first place or return for continued treatment.

Magellan Health Insights: How can everyone, including healthcare professionals, best support minority mental health?

Dr. Rakel Beall-Wilkins: Everyone can help eliminate stigma. Be open to talking and hearing about mental health conditions, and make it clear that you know that having a mental health condition is nothing to be ashamed of. When someone you care about is going through a difficult time, encourage them to get help, and learn ways you can support someone who coping with a mental health challenge.

As healthcare providers, we personally can help by:

• Ensuring we are taking into account each person’s wishes when referring them to other providers: We should ask every patient whether they prefer to see someone of a specific race, ethnicity, gender or sexual orientation.
• Educating ourselves to be more culturally competent and making cultural training a priority for our staff.
• Expanding our workforces with staff from various backgrounds, sexual orientations, cultures and with varied linguistic skills particularly for the unique cultures that are most prevalent in the community.
• Screening for psychiatric conditions during routine visits. Many patients will report physical symptoms instead of talking about the underlying mental health concerns. PCPs and others see many cases of mild or moderate depression during routine care, and screening every patient can help prevent costly emergency visits and admissions. Self-screening tools can also help.

Beyond what we can personally do to educate and equip ourselves and our staff, I believe that the best solutions come from an integrated, collaborative approach. Everyone can help eliminate the disparities. If we work with leaders in the community, for example in churches and schools, we can raise awareness of mental health conditions, destigmatize treatment seeking, help address the social determinants, and improve the lives of everyone in our communities.