How Magellan Health Selects Behavioral Health Partners: A Conversation with Magellan Health President of Behavioral Health Dr. Caroline Carney

Behavioral health stands apart from other health care specialties, for one, because of a lack of standardized outcome measurements.

Without these markers, health plans must evaluate potential provider partnerships through a different lens, developing alternative criteria to ensure high-quality treatment for members and cost savings for the health plans.

In this BHB+ TALKS conversation, reporter Morgan Gonzales sits down with Dr. Caroline Carney, president of behavioral health and chief medical officer at Magellan Health, to dive into how Magellan Health identifies behavioral health providers for potential partnerships.

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The conversation also includes Carney’s insights into an example of a successful value-based partnership, how Magellan Health’s approach to behavioral health has evolved over time and persistent issues that plague the behavioral health industry.

The full transcript from BHB’s conversation with Carney is below for BHB+ members.

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Morgan Gonzales: Hi, and welcome everyone to this episode of BHB+ TALKS. I’m Morgan Gonzales. I’m a reporter with BHB. Today I’m joined by Dr. Caroline Carney, president of Behavioral Health and chief medical officer of Magellan Health. This is our third BHB+ TALKS conversation, our new monthly executive interview series that comes with your BHB+ membership.

All right, let’s get rolling. Dr. Carney, could you take a moment to share just a little about your background and your role at Magellan Health?

Dr. Caroline Carney: Absolutely. Thank you, Morgan, so much for inviting me and Magellan Health to participate in this [conversation]. It’s a privilege always to be able to speak about what we’re doing at Magellan, and I’m excited to talk about it today.

My background – I’m an internal medicine doctor. I’m also a psychiatrist. The whole of my career, I like to joke, was that I was doing integrated care before it was cool, before it was the thing we were all talking about, because of the importance of whole-person care and what it meant to me, to be able to really take care of a person throughout all of their needs when I was a clinician and a researcher. I’ve been at Magellan for the last eight years, first as one of the medical directors for behavioral health, and ultimately chief medical officer of the whole company of Magellan. When we became focused 100% all day, every day on behavioral health, I became president of the company.

Gonzales: Awesome. I’m so excited to get to pick your brain. To start, could you tell us how Magellan Health’s approach to behavioral health has evolved over time? It seems like there’s been some changes.

Dr. Carney: Absolutely. Many of those changes have occurred in the last few years under this change to being led by a clinician and managed with that clinical-first experience in mind. I would say that traditional Magellan is one that was a heavy-handed, utilization management-first company that really cared about managing the health care dollar for our contracts as opposed to the member as much as that has evolved over time.

Today, I wake up, my teams wake up, the supporting teams wake up, all day, every day thinking first about what is best for the member and what is best for the providers that support them through engaging in sensible, but not excessive, utilization management and clinical programs and care management programs that really move the needle in terms of quality in outcomes.

Gonzales: You said that’s been just in the past few years?

Dr. Carney: Over the last several years, we’ve evolved in that direction, and I would say that the pandemic really fueled that advancement even further.

Gonzales: Now if you had to narrow it down, what are Magellan Health’s three primary areas of focus in behavioral health right now, and why are these important?

Dr. Carney: The first is, I’m going to hearken back to what I just said, it’s about the member and the provider. So in creating the clinical programs, creating the network experience, the availability of providers for our members to provide the best in evidence-based high-quality services. Sometimes that might mean that every provider won’t make the cut because we do know that there are providers who are not necessarily engaging in evidence-based services like cognitive behavioral therapy or dialectical behavioral therapy and so on. We want our members to have the best-in-class types of services for their needs. We want to also make the journey for our providers simple so that it is not rigorous [utilization management] (UM), calling back and forth, faxing back and forth and all those sorts of things of the days of old. We really want that more holistic member and provider-driven approach. I think we’re doing that really well. Our surveys show that we’re doing it well. Our approaches have led to the kinds of things coming in from the community that make me really happy to see.

No. 1 is, how do we get there through building networks, through creating value contracts, through bringing in the right telehealth supports or the right digital supports? That’s No. 1.

No. 2 is really a focus on special populations. Whether that’s in our commercial health plan or our public markets direct to, say, state Medicaid programs, our federal business or our employee health business, we have a focus around bringing the kinds of programs that will make a difference in people’s lives.

For instance, we are further growing our suicide prevention program. That program has early success. We see it in the numbers, which is really important to me, that our proof of concept has proof. We’re building that across the company. That’s a program that’s end-to-end, Morgan. If we start using AI technology with one of our health care partners called Arine and identify people who are at high risk for committing suicide, we have a care management approach of outreach to touch those individuals before the worst happens, so that we have a signal out there that says, “This person might be in trouble.” It’s worth making that gesture to reach out to them, to engage them, to bring them into services, instead of waiting and having that person just suffer silently in the community.

Then the second is if someone does have an attempt, at the time we recognize that, when they come to us through the care management program, at the time of discharge, we’re arming our members with a tool called NeuroFlow, which allows us to push out evidence-based supports to our members. It allows us to engage with our members and to, importantly, push out measurements so that we can get a signal that their PHQ to measure depression may have worsened. In the old days, think about it. You would go in to, say, the emergency room and have an event. Then no one would touch you again until you happened upon your next provider appointment. This tool allows us to stay engaged with the members so that we don’t just release someone from the ER or from the hospital without having the right kinds of supports behind them. It’s really, really cool technology that’s allowing us to do this.

Gonzales: Then if I could pause you for just a second, what does NeuroFlow look like from a patient perspective?

Dr. Carney: It’s an app and it takes a couple of minutes to sign up for. Our care managers are trained to help individuals sign up for it. It’s a really user-friendly interface that allows us to do a lot. Many apps aren’t sticky. They offer one thing and individuals might get tired of it or move on to the next shiny penny. What NeuroFlow does is allow Magellan to have the ability to really scale our programs. We’re not just saying, “Here’s an app. Go use it.” We’re using that technology to support our care management programs, our collaborative care programs, our suicide prevention programs.

That app interface does everything from assessments to full-scale, evidence-based cognitive behavioral therapy built in the app. You could do therapy any time of the day or night for anxiety, depression, sleep/insomnia, pain management and so on. Plus, we have modules for kids and adolescents in that app so that the kind of support that’s needed may be given to someone while they’re waiting for that next appointment to come around. The app also has really cool interfaces in it. It does use the kind of technology used in gaming that gets people engaged, so we can keep people sticky using the materials. They can journal in the app. They can look up articles in the app. Importantly, if they are reaching a crisis; in the app, we have links to 988 and to local crisis lines. It’s really a tool, kind of a Swiss Army knife for us, if you will, that allows the clinical programs we’ve developed to really take off.

Gonzales: That’s really interesting. Thanks for the tangent. I believe you’re on your third point of Magellan’s priorities.

Dr. Carney: Yes. No. 3 is kind of a “three and a four,” if I can take that opportunity. Three is going deep into the kinds of programs that are important to our population. I mentioned suicide, but there are other really high-risk populations, children who are in state custody or supportive services, those kids in the foster system. Our Medicaid programs across the state really are paying attention to providing those children with the best possible supports. We are right alongside many of those states providing supports to those kids, so we’ll be growing and expanding those. Related to that peer support and recovery support navigation, we have had a leader in this area who’s tremendous, who is a peer herself, who has brought together our programs, wherever they may have lived in the company, to have really a center of excellence focus.

The third and fourth center of excellence, I know I’m pushing here, but is in residential treatment. That is an area in the country that really needs to have close attention paid to ensure that individuals who are going into residential treatment have the right kinds of services and protections and can get to the best outcome. We’re creating a center of excellence model around that, much like you would, say, in the transplant world, where we know centers of excellence and transplant perform better, the outcomes for patients are better, their ongoing care is better. We’re moving in that same direction for individuals who need to be in residential or longer-term treatment.

Then finally, the area that still plagues us is substance use. The trends coming into [the pandemic] were already increasing for alcohol use. The pandemic really exploded that. We are seeing all of the medical conditions come to be from alcohol use, so creating center of excellence models for alcohol, opioid, and other drug use like methylphenidate.

Gonzales: Perfect. Yes, and totally okay to have the fourth one. I don’t think anyone’s going to complain about more information, so thank you for going through those. Next, I would love to know how you identify and prioritize these focus areas. What’s the process of figuring out what’s top of mind.

Dr. Carney: Sure. From a very practical level, I look at two things. What’s important to the American people? What is it that our citizens are asking for? What do survey data tell us, survey data from the CDC or other government agencies? What are we seeing in the headlines? As many of us live in communities all across the country, what is coming to bear in those communities? For instance, in the wake of Hurricane Helene, we know that we need to have supports at the ready for individuals who may be suffering from weather-related phenomena, forest fires, brush fires, hurricanes, tornadoes, those kinds of things, because the pattern of needs that people have are similar. The responses psychologically may be similar, so having those kinds of programs at the ready is really important.

At the top of that list in our country is suicide. That is why we’ve gone so deep on that. The 2022 numbers for suicide showed a tiny bump, the CDC said consistent with the year before, but it is plaguing our young adults and our elders. Having the programs that reach out to those populations and engage those populations, that’s part of it.

The second part, to be completely forthright, is on quality and cost of care. Quality is challenging in behavioral health. There’s not a biomarker. There’s nothing that says your hemoglobin A1C is this, or your BMI is this. We don’t know. In behavioral health, there are numerous different kinds of providers and numerous belief systems: medication versus no medication, medication-assisted treatment versus AA, a psychologist versus a counselor versus an MD. There’s all kinds of beliefs about what the best treatment is. Some of us are engaging at national levels with national organizations to help really better define what quality means in behavioral health.

I believe that if we provide the best quality of care for our members and provide them the kinds of supports, like our suicide prevention program, that the cost trend will follow. That the cost trend will get better because we’re not caring only about, say, keeping someone out of the hospital, but we’re keeping them out of the hospital to provide them the kinds of supports they need so that they never have to be there in the first place.

Gonzales: Now you’ve identified these areas of focus, what are some examples of strategies or initiatives Magellan Health has instituted to address what we’re talking about here?

Dr. Carney: Sure. The strategies that we’ve initiated include some of the clinical programs that I’ve talked about earlier. What do the data tell us? No. 1. What do our data tell us about utilization and risk for our members?

No. 2, what kinds of contracts can we engage in with our providers to ensure that the levels of quality are higher? Looking at those value-based contracts with our provider organizations throughout the country for both inpatient levels of care and outpatient levels of care.

The third is engaging our policymakers to get to what I would call coherent policies in this space. Not mandates that don’t do anything really to move the needle, say, we’ll require this company to report on 15 more items, even if those 15 items aren’t actionable. It’s really to work with our policymakers to say these are the areas that matter.

Last summer I got to testify in front of the Senate hearing on collaborative care. That was incredible because we had an audience at the highest levels of our nation listening to models of care like collaborative care that will move the needle. In my role, that’s something that’s really important to me to be a spokesperson for getting out with what those evidence-based programs are that get care to people early and get evidence-based care to individuals.

Gonzales: That is just so cool. What challenges have you found in the process of addressing these concerns?

Dr. Carney: I think that the system is really fragmented in our country. Behavioral health care often starts in primary care or in specialty medical care. An individual may go to their primary care provider, have a very short visit, but be identified as being depressed during that visit, for instance, and medications may be started, but the primary care provider may tap out on their expertise. Then navigating that individual into the behavioral health system. Where do they start? Where are the points of entry into that system? Do they start with a therapist, or do they go straight to a prescriber?

That’s complicated by the workforce issues. We simply don’t have enough qualified providers in the country. We used to think – the data used to say, that we would reach the nadir in 2025, but because utilization has increased so much, which is terrific, people are getting services, but because of that need being identified, there just simply are not enough providers. We have to find better ways to get individuals into the right levels of care and be able to guide them, to help them along their way to say, “This is a short-term problem that you’re experiencing. Coaching might be better or problem-focused therapy might be better,” versus that individual who has, say, severe post-traumatic stress disorder who we know needs the right kind of treatment for PTSD. Helping them get to that right level of care and to the right spot can be a challenge.

I grew up in rural Iowa in a town of 600. There were no behavioral health care providers anywhere near me, and I would like to say that that has changed, but it hasn’t changed. It’s that way in big swaths of the country. One of the ways to help that is to use telehealth services, but there are parts of the country where that’s very challenging to do still because of broadband issues. Some of those are barriers to getting these programs out.

Gonzales: I feel like these are issues that I hear about across the industry all the time, so that makes a lot of sense. I’m from a town of 50,000 people. I thought that was a small town growing up, it felt like, but you win.

Moving on, Dr. Carney, I want to talk about a topic that I believe is of special interest to you. Can you discuss the impact of reducing social media use and screen time on mental health and how Magellan Health is addressing this issue?

Dr. Carney: Absolutely. I am the mother of three, and this has been almost a phenomenological experiment for me watching my oldest not have as much access, to my youngest having it be endemic, where they’re on their phones in the classroom all day, every day. I’ve seen this transition over a period of time. When I think about the use of smartphones and social media in kids and in teens, I see a lot of what I think is preventable from really scaling back on the use of the phone.

The first is being able to be in a group of people, physically, having communication. We know that that is something that has become more and more challenging for teens now and young adults. The second is the effect of sitting all day in front of a screen or on a phone on individuals’ physical well-being. Not only the kinds of injuries, say, to your thumb or your hands or your neck, but just the physical sitting and not engaging in outdoor exercise or even indoor exercise, but doing something else with your body.

The third is moving away from things – and this is going to sound silly, probably, but there’s evidence to show that not only exercise improves mental health, but doing something with your hands like a craft or building something; the kinds of things that many of us had growing up that are not as common today, in large part because they’ve been replaced by some sort of interface with a phone or a computer.

The next is the content of what we see come through in social media. For kids to be engaged the better part of their waking hours watching TikToks or watching Reels instead of growing and expanding their interactions in other ways or expanding their minds, say, through reading, all of those have had some detrimental effect. Probably the worst of all are the kinds of algorithms that seem, in particular, to have affected young women around trying to reach standards that are not possible to be reached based on the content that they’re seeing from their phone. When I was young, maybe you saw in Teen Magazine or something. There was some interface that you might come across. Today this stuff is in front of kids all day, every day, literally most of the waking hours of their day.

There’s also tremendous evidence about the effect of using a phone in your bed or falling asleep with a phone and the effect on the sleep cycle. If I see a kiddo the next day in school who is fidgety, he or she may have been on their phone, and what they have is not ADHD, it’s from sleep deprivation and trying to self-stimulate, and so I think it leads downstream to potentially misdiagnosis also.

There’s a lot there to unpack. I know I’ve said a lot, but there are things that parents can do. There are things that our schools can do. There are good things about phones in terms of some of the social interactions that they bring and some of the view-into-the-outside-world that they bring, but we can limit the amount of time that individuals spend on a screen or a phone. We can mandate no phones at the dinner table, no phones at bedtime. There are really practical, easy things to do. One of the things– I’m going to wear my parent hat and not my Dr. Carney hat, but my parent hat for a minute. I have parents say to me, “But they just want to be on it all the time,” and my response is, “But you’re the parent, so model it. You yourself, don’t stay on your phone all the time. Don’t have a conversation with your child while you’re on your phone. Engage with your child. Teach them. Be present for them so they can learn how to be present for others. At the end of the day, you’re the parent, so you have the ability to take the device away at bedtime.”

Gonzales: There’s so much interesting there, I think especially the potential for a misdiagnosis. I don’t think that’s something that I had thought about before. Now I have notes to go for a walk, crochet, and read a book after work today.

Dr. Carney: It’s true. I’m so sorry. My children would probably be mortified hearing me say that, but the evidence is there. It’s true. Go for a run and come back and crochet. Don’t just go straight to your phone. Read a book or whatever. Whatever that thing is that’s not your phone that makes you happy or engages your child’s imagination.

Gonzales: Perfect. We all have our homework now. Circling back to your first point when we first started talking about finding partners and providers, what qualities are essential for a successful partnership between Magellan Health and behavioral health providers?

Dr. Carney: I think today those qualities are evidence that the provider is engaging in evidence-based practices. We can know from the conversations with them and from their practice that they’re using tactics like cognitive behavioral therapy. We know that the tactics are evidence-based, they’re driven by evidence and they work.

The second is that they see individuals for an appropriate amount of time for the kind of diagnosis that an individual has. I’m still a clinician. If I have to see a person with an episode of depression every week for a year, then either maybe I have the diagnosis wrong or what I’m doing isn’t the right thing for that member because we should be able to treat individuals, knowing that some diseases are chronic, but not at that same level of care all of the time. Again, back to a good evidence-based practice.

Providers who want to engage in quality, who want to measure the outcomes that their patients achieve. We don’t know if someone’s better if we don’t measure it, so providers who are engaged in measurement-informed kinds of care. Then we can lead with that into quality contracts and value contracts with providers.

I also really appreciate dialogue with providers to understand what it is they’re facing and to educate us about what it is they’re going through so that we can make something better together instead of festering and being angry. Let’s work on these things together. Let’s make the system better together. We shouldn’t think of it as the government is over here, and the providers are over here and the health plans are over here. We really have to think about how we get there together.

Gonzales: Can you share an example of what has been a successful partnership or collaboration and what made it successful?

Dr. Carney: Sure. In the state of Pennsylvania, we’ve had value contracts for some period of time. In those contracts, the providers receive upside payments for meeting different levels of quality. Specifically, in those contracts, when there are savings at the end of the year, that savings goes back into the program. It’s this great combination between the counties, the providers and Magellan to create the best types of outcomes for those members and roll that back into a program.

Gonzales: Taking a step back from what we’ve been talking about, what other trends in the behavioral health industry at large have you been following most closely and why?

Dr. Carney: There are three, and truly, I’ll stick to three this time. The first is the quality issue that I talked about earlier. We can’t have open access without understanding if people are getting the right quality of care. We see evidence of this coming up in what we read in the paper about areas in the country or certain situations where that quality of care is not what we would want anyone to ever receive. Quality is No. 1 for me.

No. 2 is looking at the drug pipeline. The drug pipeline for the new medication for schizophrenia, the delivery of medications to our members, medications being driven by the genomic information to, say, get to the right medication, and what will happen with psychedelics. Will they ultimately have enough evidence to be approved by the FDA? If so, under what circumstances, and how do we ensure safety for individuals who may be on those therapies? That area all around pharmacologic treatment in many different ways is there.

Then the third is AI. This will go back to me maybe sounding really old, I think AI needs to support all of us in doing what we do best, but it can’t replace the human ultimately, especially in a counseling situation, or a psychiatric situation, or other medical situations where the human touch, the eye contact, that voice is important. It can help us be better. It can workforce expand what we do to make sure that individuals get the right services, but to ensure that AI is used practically, safely and in a way that continues to promote the fact that we need human touch in medicine. It’s always said there’s an art and a science to medicine. I think AI is one of those areas where that’s going to really bear true over the years.

Gonzales: So no AI therapists for the immediate future.

Dr. Carney: I didn’t say that. You can start with an AI therapist, say, for a really focused problem. But if an individual isn’t getting better, or there are signals that this person is using an AI therapist but they’re still in the emergency room, and they’re still landing in an inpatient setting, or they still have multiple physical issues that somehow there’s not a diagnosis for because it’s really anxiety, AI can’t pick up on all of that. We have to use it in a smart way. Maybe it is the entrance into treatment, but it doesn’t replace the continuum of care, that full patient journey.

Gonzales: I appreciate you making that distinction. I’m excited and lightly nervous to see what happens with AI in the future. To round out our conversation, what are the next big goals or projects for Magellan Health in the behavioral health world?

Dr. Carney: It goes back to those last three that we just talked about; really being a leader in the quality conversations in the country, being at the forefront of helping to define what that means. Is the seven-day follow-up from a behavioral health hospitalization the thing that we should all hang our hats on and say, “This means high quality,” or is it the patient-reported outcome who says, “Yes, I’m better”? What one would you rather follow? Today that conversation is erring toward things you can measure from claims. I really think we have to move beyond, so being a leader in that area.

The second is embracing the different kinds of therapies out there. While I focused on medication therapy; looking at that center of excellence model for residential treatment, for substance use, whether that’s using medication-assisted therapy and growing that more, but really, truly having a center of excellence model where we know when an individual goes to services, we have a predictable outcome that they’re going to do well in those services.

The third is bringing AI in, where it makes sense to support the work that we do to make us more efficient and more effective, more cost-effective in the work that we do. Then underlining all of it is to continue to listen to those signals out there. What are our people telling us is important to them?

Gonzales: Perfect. Thank you so much, Dr. Carney, for making the time to share your expert insights. I learned a lot. That wraps up our third-ever BHB+ TALKS conversation.

Dr. Carney: Thank you so much, Morgan. I really appreciate the time today and your very thoughtful questions. Thank you.

Gonzales: Thank you. Thank you to our live viewers for tuning in. Thank you for everyone tuning in on demand. Keep an eye out for all our future BHB+ TALKS on your dashboard, recordings and transcripts. I’ll see everyone next time.

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