Providence Health Plan (PHP) is a not-for-profit health insurance provider that is part of the integrated healthcare system and all lines of business, including Medicare, Medicaid, Commercial, Administrative Services Only (ASO) groups, and Individual & Family plans.
The purpose of the PGY-1 Managed Care Residency program is to build upon the Doctor of Pharmacy (Pharm.D.) education and outcomes to develop managed care pharmacist clinicians with diverse evidence-based medicine, patient care, leadership and education skills who are eligible for board certification and postgraduate year two (PGY2) pharmacy residency training. A managed care residency provides systematic training of pharmacists to achieve professional competence in the delivery of managed care pharmacy practice.
To that end, the PHP PGY-1 Managed Care Residency program is dedicated to providing the resident with the knowledge and leadership skills needed to pursue a career in a practice environment focused on providing optimal drug therapy outcomes for large and diverse populations. The program is designed to provide a solid foundation in population-based pharmaceutical care. Primary emphasis is placed on the development and implementation of medication use management initiatives and policies, medication therapy management, formulary management, quality and outcome assessment, drug information, effective communication, teaching and mentoring skills.
The PHP Managed Care PGY-1 Residency Program is dedicated to providing the resident with the knowledge, skills, and leadership ability necessary to pursue a practice environment focusing on optimal medication therapy outcomes for patients and populations. By the end of the residency program, the resident should be able to:
The PHP Managed Care Residency Program is jointly accredited by the American Society of Health System Pharmacists (ASHP) and the Academy of Managed Care Pharmacy (AMCP).
Orientation –Introduction to Providence Health and Services (PH&S) and Providence Health Plan (PHP) through new employee orientation (review of policy and procedures), hands-on training at PHP with basic computer skills, FACETS, DST (formerly Argus), and online training modules
Formulary Exception (Prior Authorization) Training – This rotation teaches residents how to review prior authorization requests and triage customer service requests that have escalated to the pharmacist-in-charge
Medication Therapy Management (MTM) – Residents will develop skills in all aspects of performing telephonic comprehensive medication reviews (CMR) and targeted medication reviews (TMR). The resident will function as an MTM pharmacist by the end of the rotation, providing appropriate patient and physician recommendations based off of interactions with patients.
Pharmacy Benefits Administration – Residents will learn aspects of pharmacy benefit management, drug utilization review, formulary management, pharmacy network development, disease management, quality assessment and Medicare Part D implementation in a large health plan.
Clinical Quality Management – Residents review current population-based national quality objectives (NCQA, CMS 5-Stars and HEDIS), establish and implement monitoring plans, and design a process to improve a chosen measure.
Pharmacy and Therapeutic (P&T) Committee –Residents engage in the Oregon Region Pharmacy and Therapeutic (P&T) committee planning and organization, complete drug reviews, and present before the committee.
Primary Care (Providence Medical Group) – Residents gain experience in a variety of primary care pharmacy services including collaborative disease state management, health care provider education, and quality improvement.
Geriatric Ambulatory Care (Providence ElderPlace) – Geriatric Ambulatory Care (Providence Elder-At-Home). As part of a multidisciplinary team, residents learn to design and manage pharmacotherapy for medically fragile, home-bound patients. Residents will have the opportunity to make home visits to chronically ill patients and do full pharmacotherapy assessments.
Principles of Managed Care – Residents will participate in regular discussions regarding managed care, leadership, and pharmacy practice topics to foster professional and personal growth.
Evidence-Based Medicine – Residents will continue to build upon skills learned during the P&T rotation by completing reviews/evaluations for ORPTC, develop educational sessions for pharmacists (e.g., journal clubs, continuing education), and answer drug information requests from colleagues and/or providers.
Practice-Based Staffing – Residents will staff in Medication Therapy Management or in prior authorization review at the health plan. Staffing will generally consist of one day per week.
Specialty Medication Services – Residents are introduced to clinical and cost-management strategies for specialty medications administered under both the pharmacy and the medical benefit. During this experience, residents will gain exposure to contracting, channel management, analytics, and program design centered around medications used to treat rare and/or complex patient populations.
Health-System Administration – By participating in meetings and projects with administrative leaders, residents will learn how a health plan works with other components of a health system (inpatient, long-term care, ambulatory care, specialty pharmacy, home infusion).
Pharmacy Client Account Management – Residents will support new and renewing business opportunities by collecting, analyzing, interpreting, and presenting health care cost and utilization information and inform clients how PHP’s clinical strategies contribute to lower total cost of care. Additionally, the resident will support the sales and account management team in the completion of requests for proposals for new business, including rate development, formulary disruptions, repricing, rebate forecasting and benefit design.
Oregon Pharmacist Teaching Certificate Program – Residents will enhance teaching skills through practical training and hands-on teaching/facilitating experience.
