Mike* was dancing wildly to hip hop music before running up to me and confidently stating, “I’m a leader.” He told me about how he ran to be a class officer and lost but how he was not going to give up. He talked about his search for a life-long mentor and how he wanted to make the world a better place. Not the type of random conversation you would expect at an outdoor community event, but MY LIFE youth are not average.

Since 2007, Magellan Youth Leaders Inspiring Future Empowerment, or MY LIFE, has proactively sought to change the trajectory of young lives engaged in the foster care and juvenile justice systems, as well as youth with behavioral challenges. Led by Greg Dicharry, Magellan’s national director for youth empowerment, monthly MY LIFE groups and annual MY FEST events have provided thousands of youth an opportunity to connect to their community and hear stories of overcoming hardships and reaching for their full potential. In Florida alone, groups in Tallahassee, Orlando and West Palm Beach enable over 100 youth ages 13 to 23 to meet monthly in a safe environment where fun and inspiration are plentiful.

Getting to spend time with youth involved in MY LIFE underscores the impact. One young man who has been attending a Florida MY LIFE group for three years described how the motivational speaker’s life lessons inspired him to focus on his future instead of focusing on his past. He told me about the hard times he was going through now and how the stories of the speakers going through tragic times provided him with the feeling that “it’s not too late for me.” It was a tough thought to imagine that at only 16 years old, this young man felt like the cards had already been stacked against him. MY LIFE provides a consistent message that he and his peers have the power and support to create a future different from their current reality.

And then there was Mike with his boundless energy. He may never lose that energy, which could either lead him down a path that is damaging to himself and others, or one that honors his strengths and abilities as he contributes to society. MY LIFE has helped him set upon the latter path. His future can now be one where his energy is directed into developing his leadership skills, pursuing higher education and a meaningful career, despite the challenges he might face at home or at school.

MY LIFE is just one way Magellan is supporting young leaders to help make our communities stronger.

*Mike is not this individual’s real name.

By Gary Henschen, M.D., senior vice president – medical management and Patricia Hunt, director of child and family resiliency services

Today, children and adolescents with behavioral health challenges are generally prescribed, and use, an alarming number of psychotropic medications. This excessive usage has raised concerns among families, practitioners and advocates amid questions about the appropriateness of the diagnoses that justify the drugs’ use – as well as the uncertainty surrounding the long-term effects of these drugs on a child’s neurological development.

Thinking ahead about the challenge

Magellan Health has had its eye on this issue for years, publishing a popular monograph, “Appropriate Use of Psychotropic Drugs in Children and Adolescents,” on the topic in 2013, which addressed the anxiety and confusion around the issue. Now – leveraging new data and research – we have released an updated monograph.

We know that appropriate use of psychotropic medications can play a role in helping children and youth with behavioral health conditions successfully live at home, achieve in school and experience positive engagement within their communities. But first parents, caregivers and practitioners need to fully understand the risks and monitor their use. When they’re used in the wrong way, these drugs can lead to a host of medical conditions and social problems that prevent youth and their families from achieving their goals.

10 questions to ask before starting treatment

To tackle this issue in the most practical way, we’ve developed a list of top 10 questions for caregivers, practitioners and the child/youth to discuss before beginning this type of treatment:

The treatment options

1. Are these medications needed?
2. Will the child benefit from therapy?
3. Did the child get a full evaluation from a behavioral health practitioner?

The medication

4. Has the medication been tested and approved for children? What are the risks, benefits and side effects?

The treatment plan

5. How will we know the child is making progress?
6. How often will the child be checked after starting the medications? What happens if we don’t see progress?
7. What warning signs should we look for and when should the doctor be called?
8. Will the treatment be noted in the child’s health care records?
9. Will the practitioner talk to the child’s other health care providers?
10. Does the practitioner know of other medications the child is taking and are there risks in combining them?

Implications

We know practitioners strive to do the right thing for the individuals they serve. With our monograph, we aim to support them in their decision-making process. Our approach is to help primary and behavioral health practitioners – as well as parents, youth and advocacy organizations – make informed decisions that most effectively meet each child’s needs. When the right medications are prescribed and monitored, they can have positive results in a child’s life.

Pat Hunt

Pat Hunt is the director of child and family resiliency services for Magellan Healthcare. In her role, she promotes meaningful involvement of families of children and youth; advances family support and education; and highlights lived experiences of children, youth and families to ensure both policy and practice align with and support resiliency and recovery. She previously held a seven-year senior leadership position with the National Federation of Families for Children’s Mental Health, with two years directing its office of policy. Pat also has served as a VISTA Volunteer; directed a federally funded, rural substance abuse prevention project; and was executive director of a statewide, family-run organization for children’s mental health.

Magellan Behavioral Health of Pennsylvania, Inc., a Medicaid managed care organization (MCO), started as the new HealthChoices behavioral health exclusive contractor for the Cambria County Behavioral Health Services Program on July 1, 2017. Magellan currently administers behavioral health benefits for Medicaid members through HealthChoices contracts with Bucks, Delaware, Lehigh, Montgomery and Northampton counties.

Magellan has over two decades of experience managing behavioral health benefits for HealthChoices members through close collaboration with members, providers and community organizations. Through this collaborative mindset, Magellan has succeeded in producing innovative efforts in the following areas:

• increases in access to care
• improved service use rates
• expansion of the continuum of services in alignment with evidence-based models
• maximization of clinical appropriateness
• nationally recognized level of quality services

Read more about Magellan’s collaboration with Cambria County, local providers, community organizations and members in the Tribune Democrat: New Behavioral Health Provider Brings Options, Jobs to Cambria County.

Being a parent is one of the most challenging and rewarding jobs an individual can hold. When behavioral health challenges are added, it becomes even more difficult. Try, for a moment, to imagine being a foster parent to a child with behavioral health challenges. Where does one even begin to find the help and services they need to best care for their child?

Through our collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan in Wyoming coordinates care, including behavioral health interventions with other youth serving agencies in our system, using the High Fidelity Wraparound (HFWA) model to build a team of support for the successful management of complex conditions and behaviors in home- and community- based settings. The team creates steps to help youth stay in their homes, schools and communities. Through the 10 guiding principles of the program, families and youth have a voice in their care and choice in the kind of care they receive. We help to strengthen community support, understanding, and education of at risk youth ages 4-20 with complex behavioral health needs.

Magellan in Wyoming recently had the opportunity to hear from a former foster parent and HFWA graduate to discuss how the program benefited them through their challenges and supported their growth. “Opening my heart up to love and attachment with these children, parenting them with unconditional love, all the while knowing, they might not stay was difficult,” said the foster parent.

The siblings involved and their foster family cycled through numerous foster care workers in three years, creating more trauma for everyone. There was no stability and no consistency. Dealing with several different mental health diagnoses and many weekly appointments, in addition to the strain of everyday life, took a toll.

When this family discovered HFWA, they were naturally a little skeptical. They had experienced enough “new” things; however, this was the beginning of a completely new outlook on life. From the very start, HFWA taught the foster parent that it was okay to take a breath, to sleep and to ask for support. More importantly, it became evident that people wanted to help and be on the family’s team to help support them.

The family had spent so much time triaging the risk aspects of their children’s lives, that it had drained them of most of their hope. Through the strengths-based principles of the HFWA program, the family was able to gain new insight into ways they could focus on the local supports available to help them.

The program taught them to see the progress. By forming a HFWA team around the foster children and the whole family, they were able to gain some positive, strengths-based perspective along with stability and consistency.

HFWA empowered the family to have a voice and to use it effectively. “I knew all the people on my team before HFWA, but the program taught me how to use my voice. It taught me how to say what was going on and who to say it to,” said the foster parent. It was because of the family’s team, as well as community investment in the program, that today, the family is enjoying a life full of hope and possibility.

When I was selected to join the National Quality Forum’s Medicaid Innovation Accelerator Project Coordinating Committee, I thought about the background and experiences I would bring with me – both personally and professionally. As a trained pediatrician, my medical training focused largely on the care and treatment of young children. According to the Centers for Medicare & Medicaid Services (CMS), more than 45.2 million children were “ever-enrolled”¹ in Medicaid and the Children’s Health Insurance Program (CHIP) during fiscal year 2015. In addition, in the time since I was in practice, I’ve worked for several national healthcare companies, with a focus on population health, clinical delivery systems delivery and improvement.

Since joining Magellan as the company’s chief medical officer, I’ve worked with my colleagues to help continually looks for ways to reinvent how care is delivered. I am passionate about supporting the volume-to-value payment transformation, and Magellan has a key role to play because of the deep expertise we bring in behavioral health. Oftentimes, we don’t realize how specialized and important that expertise is, and how it impacts the overall quality of care for a patient, particularly with comorbid conditions. Magellan is also considered a trusted partner because we are an independent company and not part of a big health plan. In addition, we also bring a breadth of experience in medical specialty, medical pharmacy and long-term services and supports (LTSS) which is not found in most other organizations.

NQF’s Medicaid Innovation Accelerator Project (IAP) Coordinating Committee is tasked with identifying and recommending measures in four priority areas to help support states’ efforts related to payment and delivery system reforms.

The four priority areas are:

• Reducing Substance Use Disorders (SUD)
• Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs (BCN)
• Promoting Community Integration – Community-Based Long-Term Services and Supports (CI-LTSS)
• Supporting Physical and Mental Health Integration (PMH)

The challenges – and opportunities – are many. Medicaid behavioral health does not currently have standard benefit packages from state-to-state, and there are also not standard billing practices. Both of those elements make it much harder to develop metrics which are reliable, and more technical expertise is needed to ensure that the metrics selected can be broadly used. Ultimately, this committee will provide guidance on performance measures for areas which are unique to Medicaid, including patients with complex health needs, LTSS needs and those with behavioral health and substance use/opioid disorders. The states will then have a list of standardized measures for use in Medicaid performance program evaluation.

All of the committee’s meetings are open to the public. The IAP will issue its draft report in July, and its final report at the end of September. I look forward to working with my committee colleagues as we work to draft these important metrics related to state’s efforts regarding payment and delivery system reforms.

¹These enrollment data are unduplicated counts of children who were enrolled in Medicaid and CHIP at any point in FFY 2015. A child who was enrolled in more than one program (e.g., Separate CHIP and Medicaid) at different times during the FFY is only counted in the program in which he or she was last enrolled.

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.

According to the Kim Foundation, one out of four Americans experiences behavioral health issues. Of those, 60 percent are not receiving treatment.

Why are so many people not receiving treatment?

What does this mean for providers?

What more can be done to increase access to behavioral healthcare?

Learn more about this issue by downloading Magellan’s new infographic, “Mind the Gap: Increasing Access to Behavioral Healthcare.”

You’re buying a car. Before you hit the lot, you do your planning and research, establish a budget, figure out what features you want and what style you’re looking for. You probably search online for car and dealer reviews, prices and sales. Based on all of that work, you make a decision, negotiate and pay for your new car.

Your car research was relatively easy. But finding a healthcare provider? Not so much.

While you may know what you want in a provider, very little information is available about the services they provide, appointment costs, reviews and other important details to help you make an informed choice about your care. And if you ARE lucky enough to find someone who seems to fit your needs, you’re often still left wondering what kind of quality you can expect from your treatment experience.

The bottom line is that it’s easier to buy a car than it is to find a healthcare provider. Silly, right? We think so, too – which is why Magellan is bridging these information and quality gaps by employing value-based purchasing models.

Rewarding quality care yields informed choices

Value-based purchasing takes various forms. But it generally operates on the premise that aligning providers’ incentives and reimbursement with organizational and individual goals incents behavior and drives positive outcomes, ultimately benefiting all involved in the healthcare continuum. This includes consumers, customers and payers, in addition to the providers themselves, who also enjoy improved reputations through public reporting.

In fact, one of the key tenets of Magellan’s value-based collaboration and purchasing models is to ensure stakeholders become more informed as a result of these initiatives:

• Customers benefit by knowing whom to partner with for network management;
• Payers benefit by knowing whom to pay for value; and
• Consumers, of course, benefit by having those online provider reviews become a lot less elusive, enabling them to make an informed decision about whom to choose for their care.

Magellan’s models also center on:

• Engaging and empowering providers in compensation model evolution. We partner with provider leaders around compensation design, employ transparency to ease the compensation shift and create meaningful incentives for providers to encourage active engagement. (1)

• Building provider compensation for an evolving healthcare market. Our priorities center on population management, team-based care and member access. We integrate new quality and efficiency standards into compensation, and remove compensation barriers to population goals. (1)

Why do we give value-based purchasing strategies the green light?

Take our Assertive Community Treatment (ACT) program as just one example. Through program data analysis and close collaboration with our ACT provider teams, we developed a three-tiered rate structure based on overall program goals to support recovery, wellness, and to improve community tenure. As a result, we saw a 21 percent decrease in inpatient admissions and a 24 percent decrease in the inpatient readmission rate.

Our drive for engagement continues

Providers nationwide are in different phases of readiness, so we keep our wheels in motion by providing a graduated maturity model to move them from the most basic stage—learning the behavior through activity incentives—to the most complex arrangements, which transform care delivery through outcomes-based incentives or other payment structures (2). We look forward to working with stakeholders, providers and consumers as we continue to expand this innovative and exciting model.

(1) Medical Strategy Group Council: “Next-Generation Physician Composition,” The Advisory Board Company

(2) Physician Quality Reporting Initiative: The Advisory Board Company