April is Autism Awareness Month and another opportunity to promote inclusion and self-determination for those on the autism spectrum. Like many impacted by this challenging disorder, my family has our own story and my hope is that by sharing it, we can help others.

Our now nine year old son, Vaughn, was diagnosed with autism at 18 months. A mere 13 months younger than his typically-developing sister, my husband and I could tell that something was not quite right with our son. Vaughn wasn’t walking or talking and was overly-obsessed with anything that spun. He wouldn’t make eye contact with people and wasn’t motivated to engage with our family. It was both scary and heartbreaking and we knew we needed to do something. Little did we know how much our next steps would change, and continue to shape, our lives.

Artwork by Vaughn

The day we were given the diagnosis was one of the hardest days of my life. I worried about my son’s future and whether he would ever learn to communicate his needs, make friends or even live independently. As a mother, you want those things for your children and you worry when the future path isn’t clear. Thankfully my husband and I parked our tears and bonded together to do everything we could to change the trajectory of Vaughn’s life. We quickly immersed ourselves in learning all we could about this complex and wide spectrum disorder, discovering just how important it was to intervene early and often for the biggest impact. And we did just that; fully determined, we dove in and never looked back.

While most children were enjoying the freedoms of exploration and play, Vaughn was working as many as 35 hours a week for years on things that would seem so simple to some—things like learning how to speak and shape sounds, how to play appropriately with toys and even how to properly engage other children and people. My husband and I often marveled at how hard Vaughn worked and how little he complained. However, as parents, we often struggled to strike the balance between being therapists consistently executing interventions and being just a regular mom and a dad to both of our children.

Fortunately, and with the help of many wonderful people and organizations, we were able to effectively navigate the system and provide Vaughn with comprehensive services and support, some of which he still receives today. Vaughn is in a typical classroom, participating in typical activities and has many friends. He is a talented artist with a creativity and sense of design well beyond his years. And, most importantly, he has a loving and supportive big sister that celebrates his success, despite the years of being in her brother’s autism shadow. We are fortunate.

In an effort to honor those that have helped us and to give back to our community, I have joined the board of directors at Arizona Autism United as they have played, and continue to play, a key role in Vaughn’s treatment and success. It is my goal to do whatever I can to support this organization that has done so much for my family and share what we have learned to help other families struggling with autism in our community.

I’ve said it a million times, and will say it again. If I could go back in time to the day Vaughn was diagnosed and change things, I wouldn’t. He is such a special and creative person that has positively shaped how our family sees the world. Our journey has made us who we are and we are grateful for the lessons we’ve learned and the people we’ve met along the way. This Autism Awareness Month, take the time to learn more about autism and what you might be able to do to help those in your own community.

In honor of World Hemophilia Day, Magellan Rx Management has released results from the first six months of its hemophilia management program launched in collaboration with Health New England, a non-profit health plan serving the commercial, Medicaid and Medicare markets.

Hemophilia is a rare genetic bleeding disorder, for which treatment is expensive and difficult to manage. The average annual cost per member with severe hemophilia can exceed $250,000, and may be upward of $1 million for members who have developed inhibitors. Personalized care programs for patients with hemophilia aim to reduce unnecessary costs while improving the overall quality of care.

“As April 17 is World Hemophilia Day, we’re excited to bring hemophilia care into the spotlight and highlight the early results achieved with Health New England through our hemophilia management program,” said Haita Makanji, vice president, clinical specialty solutions at Magellan Rx Management. “Through personalized interventions, we’re able to better determine the individual member needs and coordinate across key stakeholders to deliver a truly personalized care program that ensures members with hemophilia receive best-in-class care and achieve optimal outcomes.”

Since launching the hemophilia management program in August 2017, Magellan Rx Management and Health New England have standardized care across various stakeholders without compromising patient outcomes, resulting in:

• Optimized doses through assay management or pharmacokinetic (PK) testing in 50 percent of members
• Reduced average assay dispensed in prophylaxis patients from 5 percent to 1 percent, reducing the potential for waste
• No breakthrough bleeding reported from members who had a dose reduction

“In the past eight months of collaboration with Magellan, we’ve achieved our goals of ensuring high quality of care for members with hemophilia while minimizing potential waste created through excess dispensing and inappropriate dosing,” said Andrew J. Colby, R.Ph, MBA, Health New England’s pharmacy director. “By announcing our hemophilia management program results on World Hemophilia Day, we hope to raise the profile of this condition and look to continue to make strides in standardizing best treatment practices to benefit members across the country.”

The hemophilia management program aims to enhance overall quality and personalization of hemophilia care by coordinating with prescribers, members and pharmacies while reducing unnecessary costs. Key elements include:

• Helping payers analyze information related to member bleed history and hemophilia treatment patterns.
• Standardizing dispensing and optimal dose protocols to promote best practices and improve transparency in hemophilia care.
• Updating policies to encourage individualized treatment regimens based on member-specific metabolic factors.

By Carol Sickler, Screen Liaison Supervisor, TMG by Magellan Health

April is National Donate Life Month, and in honor of this, we would like to share a story from Carol Sickler, a TMG by Magellan Health Screen Liaison Supervisor. Fourteen years ago, Carol gave a life-saving gift to her brother, and she’s proud to be a living organ donor. Here is Carol’s story.

On March 18, 2004, I donated my kidney to my brother Lee. He had been in kidney failure for a year due to Berger’s disease (also known as IgA nephropathy) and was on dialysis. Berger’s disease causes the kidneys to become inflamed, which can affect how the kidneys filter waste from the blood. Since only 50 percent of people on dialysis live beyond 5 years, Lee’s best bet for long-term survival was to find a new kidney. I wanted to give Lee a fighting chance.

Our dad had also been on dialysis due to what we believed was Berger’s disease (it was never confirmed because he had other health issues, too). Unfortunately, our father was not a candidate for a transplant, and passed away in 2002 at the age of 72. My brother Steve also has Berger’s disease, but fortunately he has not experienced kidney failure (not everyone with Berger’s does).

Lee and Carol Sickler

Since this disease is hereditary, you might be wondering why I decided to donate one of my kidneys – wasn’t I at risk of Berger’s disease, too? Thankfully for me, Berger’s is primarily a disease found in males. It also tends to show up by the time a person is 40, and I was 40 at the time. So, for me, the risk of developing Berger’s disease was relatively low.

When I first considered donating my kidney, there were so many questions that were going through my mind about both of our futures, and if this was the right choice for us. However, my decision was solidified when the doctors at UW Hospital in Madison told us I was a match for Lee. And not just a match, but an identical match, with all six antigens matching as if we were identical twins, even though Lee is seven years younger than me. The doctors were baffled by this and had never experienced anything like this before. For me, though, I knew then that it was part of my life’s path to move forward and give my kidney to my brother. So, fourteen years ago we hugged and went into surgery together, becoming connected in a way we had never before imagined.

Today, we are both fully recovered and doing well. I personally have no regrets, and no health issues or ill effects from the donation. What I do have is an amazing bond with my baby brother Lee – the depth of this bond is unexplainable, and it’s something I would gladly give my kidney for again if I had to. Because organ donations are treatments and not cures, the kidney donation didn’t cure Lee of Berger’s disease, but it has allowed him to live a fulfilling, healthier life off of dialysis. Also, this gift of life allowed him to have a daughter, Jazmyn Carol, for which our entire family is grateful.

For anyone who is interested in becoming a living donor, there are a lot of great resources at both the www.organdonor.gov and at the University of Wisconsin Living Kidney Donor page. One of the most important things to know is that as long as the donor is evaluated thoroughly and cleared for donation, they will most likely lead a normal life after the surgery. And should a health condition arise because of the donation, there is a priority system in place on the National Transplant Waiting List so that living donors move to the top of that list.

I’m grateful that I had the chance to give my kidney to my brother, and love sharing my story in hopes it will inspire others to give the gift of life.

The following is an excerpt from an article appearing in the American Journal of Managed Care (AJMC)

More than 46 Americans die from prescription opioid overdoses every day, while the number of deaths from prescription opioids has more than quadrupled since 1999. Lack of expertise on how to measure and treat pain is a large factor driving the crisis. In addition, challenges in identifying those who are at risk for opioid abuse or who are already dependent on opioids adds further complexity.

Americans consume 80% of opioid painkillers produced worldwide. Yet the amount of pain reported hasn’t changed since in the past 2 decades, according to the CDC. For physicians, this points to the need to reconsider when to prescribe an opioid—if at all. Providers face intense pressures to adequately treat pain and may not know the data that supports nonopioid therapies.

Breaking the cycle of prescription opioid abuse requires new thinking around pain management and alternative options for helping patients deal with chronic pain. The following are 6 things physicians should consider before prescribing an opioid.

You can read the rest of this article in the American Journal of Managed Care (AJMC)

Traumatic events, such as a sudden death, natural disaster, motor vehicle accident, or terrorist attack can leave children and teens feeling stressed, frightened, and helpless. Whether they personally witness the event or are exposed to it on the news or social media, children may experience intense emotions and a heightened sense of insecurity. Children’s reactions to a traumatic event depend on their age and personality, the severity of the event, the availability of support, and previous experience of trauma

Tips for all ages

Traumatic events can disrupt children’s sense of safety and result in fears and worries, nightmares, and physical reactions such as headaches, stomachaches, problems sleeping, and loss of appetite. Here are suggestions to help children through the emotional and physical challenges they may face after trauma:

• Be aware of your own reactions to the event and manage your own stress. Stay calm and offer hugs and reassurance to help restore your child’s sense of safety and security.
• Share information about the event and answer your child’s questions honestly. Listen to your child’s fears and let him/her know it is okay to share his/her feelings at any time.
• Limit or prevent exposure to disturbing news and social media coverage of the event. Children who see graphic images or hear distressing news stories may become re-traumatized.
• Maintain stable routines as much as possible, including regular mealtimes, bedtimes, and exercise.
• Engage in fun activities to help children relax and feel that life is returning to normal.
• Watch for signs of trauma, even after weeks have passed. Children cope with trauma in different ways, and some may show signs of sadness, anxiety, and troubling behavior weeks or months after the event.

Tips by age group

Preschool age

After a traumatic event, children who are age five and under may display behavior from an earlier stage of their lives, such as bedwetting, thumb-sucking, clinginess to parents, and fearfulness of strangers. They may have tantrums or cry more than usual, or become withdrawn from others. Parents and other adults can help children by providing comfort and reassurance, maintaining routines as much as possible, encouraging them to express their feelings, and giving simple explanations to children’s questions about the event. Children look to their parents for cues as to how to feel and react, and will pick up on a parent’s distress or anxiety. It is best not to expose young children to the news on TV or the radio about the traumatic event. Involving toddlers and preschoolers in fun activities and playtime with others will provide a healthy distraction.

Early childhood

Children ages 6 to 11 may show some of the same reactions that younger children have, such as reverting to more childish behaviors. They may have nightmares or trouble sleeping, find it difficult to concentrate in school, become irritable, anxious or disruptive, or lose interest in family, friends, and fun activities. Parents should reassure children that they are safe and will be taken care of no matter what. Encourage family discussion about the event and answer questions, but be careful about exposing children to news and TV footage. Keep bedtime and meal routines as normal as possible, and involve children in activities that keep them busy. Identify the positives such as community recovery activities and the ways people help each other get through difficult times.

Adolescence

Older children ages 12 – 17 may have stress reactions such as nightmares and flashbacks of the event, lose interest in school, hobbies, and friends, feel angry, guilty, or depressed, withdraw from others, have physical symptoms such as headaches, or abuse alcohol or other drugs. As with younger children, parents can help teens rebuild a sense of trust and safety by listening to their concerns without judgment and providing them with peer support opportunities. Age-appropriate volunteer activities can help teens feel useful and productive.

When to get help

Be aware of signs that a child may need extra help coping with the trauma. If six weeks or more have passed since the traumatic event and your child is not feeling better, has trouble functioning at school or at home, is withdrawn from friends and family, or continues to have physical complaints such as headaches, stomach pains, and problems sleeping or eating, contact a mental health professional.

The Centers for Medicare and Medicaid Services (CMS) Star Rating program is designed to measure and improve the overall performance and quality of care health plans provide to

Medicare beneficiaries.  Due to changes in individual measure specifications, benchmarks, and inclusion into the overall calculation, this quality rating system continues to evolve – which can make it challenging to achieve and maintain 5-Star performance.

Listen to our latest webinar to learn about clinical strategies that can help you stay ahead of the curve for various Part C and D clinical measures such as rheumatoid arthritis management, osteoporosis management, statins in diabetes, and medication adherence for diabetes, hypertension (renin-angiotensin system antagonists), and cholesterol (statins).

This article first appeared on KevinMD.com. You can read it here.

After being prescribed opioids for just one day, individuals can face significant challenges with addiction, with six percent continuing to use opioids a year later, according to the Centers for Disease Control and Prevention (CDC). The likelihood of long-term use increases sharply after five days of use.

While much of the discussion around the opioid epidemic has centered on the challenges of opioid use and recovery, to get to the root of this national public health emergency, providers must focus on diminishing the risk of addiction before patients take their first dose.

How can providers best help patients reduce the probability of addiction when prescribing opioids? There are five key strategies providers should consider as a first line of protection against dependence and addiction.

Pair patients with chronic pain management coaches. Ideally, this step should be considered before an opioid is prescribed. Pain management coaches use digital therapy and motivational interviewing to help patients manage their pain without turning to opioids. When patients are prescribed a short-term dose of opioids, pain management coaches can be used to help transition patients off opioids by teaching techniques to manage pain without turning to opioids.

Partner with behavioral health experts who can identify patients who are most at risk of addiction. To avoid an opioid addiction before it starts, providers must understand the factors that increase patients’ risk of becoming addicted. These include behavioral health conditions such as depression and post-traumatic stress disorder—conditions that contribute to the experience of pain. Look for tools that can help identify patients’ behavioral health risk factors at the point of care, and establish partnerships with behavioral health professionals that help ensure patients also have access to pyschosocial treatment as needed. Some behavioral health solutions enable patients to participate in their treatment virtually, providing access to care for rural patients for whose availability to local behavioral health resources presents greater challenges.

Follow best practices on dosing limits. Ensure the morphine milligram equivalent dose and duration of treatment prescribed follow CDC and Centers for Medicare & Medicaid Services (CMS) best practices. Consider non-opiate alternatives before prescribing opioids, and carefully evaluate whether long- or short-acting opioids should be used based on CDC and evidence-based guidance.

It’s also important to collaborate with payers and pharmacists to gain visibility into patients’ past history of opioid use and evidence of previous substance abuse prior to writing a prescription. Patients who are at high risk of becoming addicted to opioids include those who have faced challenges with addiction in the past and who frequently visit the emergency department for pain relief. This information could help determine whether opioids are prescribed and, if so, the specific dose and duration of treatment.

Proactively engage patients in their treatment. Educate patients on the use of non-opioid medications that are just as effective as opioids.  When opioids are necessary, talk to patients who have been prescribed opioids for the first time on how they work, the risks of opioid use, and how to use opioids appropriately to reduce the risk of addiction. Consider this being much like informed consent before any medical procedure. Look for ways to engage patients not only in managing their use of opioids, but also in managing their physical and behavioral health, before, during and after using opioids.

Offer 24/7 access to healthcare professionals for patients who have been prescribed opioids. Doing so will provide a critical resource for patients who need help understanding their opioid prescription or feel as if they have a problem managing their response to their medication. Know your state’s Good Samaritan laws to ensure users of opioids that it is safe for them to seek care. Consider a hotline for opioid-using patients, staffed by nurses or an outside service to give patients and providers instant access to expert guidance.

Best practices for a complex challenge

As the opioid crisis continues to evolve, understanding the factors that place patients at highest risk of addiction before opioids are prescribed is key. Taking proactive measures to evaluate whether opioids are truly needed and how to best manage patients’ use of and response to these highly addictive drugs is critical to helping patients avoid serious health complications and live healthy, vibrant lives.

More than 70 healthcare thought leaders, providers, and other innovators gathered in Florida in late January to explore the profound impact that new disruptors are having on healthcare delivery models, financing approaches and outcomes.  For the third year in a row, Magellan Health’s ‘Magellan Open Vision Exchange’ (MOVE) innovation forum brought together executives, providers and analysts to collectively discuss how industry innovators can solve some of healthcare’s biggest challenges.

Over the course of three days of dynamic interaction on Amelia Island, the group participated in presentations and discussions from a wide range of experts – including a Pulitzer Prize-winning practicing oncologist, CEOs of several large public and commercial healthcare programs, futurists, entrepreneurs, and innovation change gurus.

The speakers at MOVE 2018 brought very different perspectives, but the messages they delivered hit remarkably consistent notes.  Healthcare is being transformed through ever accelerating advances in technology, leveraging the power of big data, and producing personalized health solutions that are radically changing the way disease is predicted, identified, treated and contained.  As more than one expert noted, many of us do not even realize that ‘deep learning’ – as population-based meta-data analysis is known – has already made its way into our homes, and indeed into our pockets.  Sam Srivastava, CEO of Magellan Healthcare, reminded us all that the humble Smartphone has much more computing power than the early super-computers.  Pulitzer Prize-winner Siddhartha Mukherjee explained how researchers are using voice data passively recorded on Amazon’s Alexa™ to identify early-stage Alzheimer’s disease.  And, as eminent futurist Jim Carroll noted: “Connected health homes are the new normal.”

How do these profound changes impact the healthcare delivery system? Or as one audience member mused:  “In a world where computers make most of the clinical decisions, what becomes of the traditional provider?”  The answer was encouraging.  Several panelists felt that when machines take over routine diagnostics and health maintenance, the doctor-patient relationship will actually be enhanced, as primary care providers will have more time to actively listen to their patients, and more flexibility to address the non-clinical determinants of health that positively impact healthcare outcomes.

In the short term, providers are preparing for a transformed healthcare landscape by investing time and resources in creative partnerships with health plans and health informatics leaders in an effort to re-define and augment their value proposition.  Leaders from Magellan’s healthcare and pharmacy divisions joined with GuideWell of Florida in a panel discussion that explored the ‘volume to value’ shift in Value Based Purchasing (VBP).  Participants suggested that, while finding the optimal value-based model has been elusive, some promising pilot programs are emerging.  Aligning provider and payer incentives remained a challenge, the group agreed, and even the best-designed VBP program will fail if it does not drive member accountability.  Dr. René Lerer, president of GuideWell, captured this sentiment perfectly when he said that an effective health solutions company no longer delivers managed care – but instead ‘delivers a managed life to each and every member.’

In other words, the key to good personalized medicine will always be the person at the center of the healthcare journey.  Tommy Duncan, CEO of Trusted Health Plan, revisited this theme forcefully when describing how his inner city D.C. health plan was able to achieve a remarkable operations and financial turnaround in only one year.  The secret, Tommy explained, was that Trusted pivoted its existing care management model completely to focus on high-touch, face-to-face interactions at brick-and-mortar ‘Wellness Centers’ staffed by interdisciplinary teams.  Using predictive modeling data as a starting point to identify high-risk, high-cost members, the Wellness Center model generated behavior change at the individual member level that resulted in a 60 percent drop in emergency room visits in only one year.  Erhardt Preitauer, CEO of Horizon Health New Jersey, delivered a similar message, and ended his discussion of long term care best practices with the comment, “It all comes down to personal engagement.”

MOVE 2018 came full circle with closing comments delivered by Barry Smith, CEO of Magellan Health.  Many presenters talked at length about vast cloud-based, technology-enabled data repositories. Barry brought the discussion back down from the data cloud to an intensely human level, when he told the story of how a group of 80 compassionate strangers formed a human chain to save a family in distress on a Florida beach not too far from the room where MOVE attendees were sitting.  The group of strangers bonded spontaneously around a common goal, unanimously determined not to fail, and focused single-mindedly on ensuring not a single member of the stranded family drowned.  As a vivid metaphor for MOVE 2018, Barry’s story moved everyone who heard it.  It was also a perfect reflection of Magellan’s purpose:  “leading humanity to healthy, vibrant lives.”