Introducing MRx Navigate

Introducing MRx Navigate: Whole Patient Care Meets Digital Innovation

The new medical management program MRx Navigate offers integrated high-touch and high-tech solutions to enhance and simplify the healthcare experience for health plans and their members.

Caroline Carney, M.D., M.Sc., FAPM, CPHQ Chief Medical Officer Magellan Rx Management

In October 2019, Magellan Rx Management (MRx) introduced a new multifaceted, holistic medical management program, MRx Navigate, to support MRx pharmacy benefit manager, employer, and government clients by providing an integrated view of the member and to offer standalone services for other clients.

Through MRx Navigate, members have access to a coach or care manager when they are newly diagnosed with a health condition, recently discharged from the hospital, interested in making a lifestyle change, or have questions about healthcare decisions. After an initial connection is made, MRx Navigate staff will proactively reach out to members and provide comprehensive education and adherence programs to improve healthcare decision-making and engagement.

MRx Navigate eliminates gaps in care and improves adherence through digital tools, online resources, and apps — and by leveraging analytics that identify members at risk for nonadherence or ineffective medical and pharmacy utilization. Driven by data-led, evidence-based algorithms, the program uses data from multiple sources to identify members in need of care-management or disease-management outreach and determine the intensity of intervention needed. Additionally, utilization-management support is provided for medical and behavioral health requests for services.

MRx Navigate is a comprehensive program including four different programs to cover multiple facets of care management.

1. Navigate Change

With the objective of assisting members on their road to recovery, Navigate Change connects members with nurses, behavioral health professionals, and clinical pharmacists. The Navigate Change team works to ensure members receive the proper medications, education, and network resources that will

help them avoid a return visit to the hospital. Care managers take customized approaches based on members’ individual needs, assessing impacts to quality of life and financial costs. Clinical pharmacists are available to assist members with medications by reviewing compliance, side effects, interactions, and any questions or concerns raised by a member. Navigate Change has targeted disease states for transitions in both care and care management (Table 1). Internal data suggests that access to a collaborative team of a pharmacist and care manager can reduce hospital readmissions by 50%.

Table 1. Targeted Disease States

Transitions in Care Asthma/COPD Behavioral Health Congestive Heart Failure CVA/Stroke Diabetes Heart Disease Readmissions

Care Management Cancer High-Risk Pregnancy Pain Management Transplants Dialysis Large Claims Multiple ER Visits Out-of-Network

2. Navigate PopHealth

The population health management program Navigate PopHealth reviews for gaps in care and implements a care plan to reduce or eliminate identified gaps. Informed by data analytics, Navigate PopHealth identifies members who have chronic health conditions and who may be at risk of nonadherence, coordinates care, and reviews social determinants of health that may be impacting health outcomes. Once members are

Informed by data analytics, Navigate PopHealth identifies members who have chronic health conditions and who may be at risk of nonadherence, coordinates care, and reviews social determinants of health that may be impacting health outcomes.

identified for gaps in care and/or nonadherence, member engagement is initiated by an appropriate care manager (nurse, pharmacist, or behavioral health specialist). Once outreach is initiated, the care manager and member agree to a scheduled contact cycle where the care plan goals and challenges will be reviewed and discussed. Through Navigate PopHealth, members will also have access to educational materials and resources to make the best healthcare decisions.

Members with specific conditions (Figure 1) will have access to a variety of resources. Nurses, pharmacists, and behavioral

Figure 1. PopHealth Chronic Health Conditions

Osteoporosis Kidney Disease Congestive Heart Failure

Cerebrovascular Accident/Stroke Behavioral Health Diabetes Chronic Obstructive Pulminary Disease Hypertension

Heart Disease Asthma

health professionals consult with members to help them manage their chronic conditions and can assist in discussions with members’ physicians.

3. Navigate Wellness

Navigate Wellness aims to identify diseases and increase members’ quality of life through educational tools and resources. Onsite biometric screenings, flu shot clinics, and mobile mammograms educate members about their health and wellness and keep them healthy by preventing more serious and costly complications. Onsite programs, challenges, educational resources, webinars, and wellness coaches help members set and achieve their wellness goals. Navigate Wellness helps members focus on a healthier lifestyle, which impacts their day-to-day activities both at work and at home. consistent with the standards required under the program’s certification by the National Committee for Quality Assurance. A standard suite of reports to track trends and identify opportunities is regularly reviewed with clients.

Objectives and Commitments:

Prevent fraud, waste, and abuse Refer members into care management Minimize readmission through transition of care Provide medically necessary care based on nationally recognized clinical guidelines Efficiently manage turnaround times Provide comprehensive peer-to-peer review

Where offered, wellness programs have had a positive impact on employees. At worksites offering a wellness program, a higher rate of employees exercised regularly and actively managed their weight.

Onsite programs include flu shot clinics, mobile mammograms, biometric screenings, wellness seminars, and health fairs. Navigate Wellness also provides access to virtual resources, including personal wellness coaches, wellness challenges, videos, newsletters, blog posts, health risk assessments, nutritional assessments, and sleep tips.

4. Navigate UM

The utilization management program Navigate UM focuses on ensuring members receive the proper medical and behavioral healthcare. The program covers prior authorization for medical and behavioral services, concurrent review of inpatient admissions, transition of care assessment, and appeal management. It documents requests for review in an integrated platform connected to available care-management services and utilizes industryleading evidence-based care guidelines. The Navigate UM team of intake specialists, nurses, and physicians perform these services

Unlock the Possibilities for Better Care To learn more about how Magellan Rx Management and MRx Navigate can help your organization, contact us at MRxInquiries@magellanhealth.com or visit magellanrx.com.

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