Rotation 3: Clinical Managed Care?

Posted by Unknown at Sunday, October 08, 2017

Hello Everyone! Back and busier than ever. I just completed my nontraditional rotation in managed care. Managed care was a setting that I quickly closed the door on because I didn’t know much about it. However, when the time came for us to rank our placements for APPEs, I realized that I should probably leave that door open in case I ended up liking it. I had the chance to explore everything before narrowing down my options. I didn’t want to be too picky. And honestly, I’m glad I had the chance to do managed care. The interesting part about my site was that it was managed care yet clinical. Classmates were telling me this about my site and I did not understand it, but now that I have completed 5 weeks there, I see how! My site focused on worker’s compensation and had a goal of reducing the opioid epidemic.

What I enjoyed about this rotation was that every week was different. I had different goals and different projects for each week, focusing on different areas of managed care. The first was dedicated to reading the different guidelines for each state. Most states follow the Official Disability Guidelines (ODG); however, quite a few states have their own disability guidelines, such as New York, California, and Louisiana. I was expected to be familiar with all the guidelines for each state.

By week 2, I knew the guidelines and I was ready to move on to the next step—IMEs. This stands for insurance medical exam or independent medical exam. It’s a document that we write after looking through an injured worker’s profile. We have to look at the medications they are taking through worker’s comp (mostly opioids) and the duration of therapy as well as drug-drug interactions. The morphine equivalent dose (MED) also played a huge role when documenting IMEs. Majority of the time, the medications are inappropriate for an injured worker and it was our responsibility to make sure the document clearly explained why the patients should not be on those medications. Once we got the hang of IMEs, we started utilization reviews (UR) by week 3. URs were similar to IMEs but shorter and less detailed. It was a brief summary of what would be in the IME.

Week 4 was when the projects started up. My co-intern (Ferris State pharmacy student) and I worked together on two projects. One was on psychotropic drug abuse, where we had to research the most commonly abused psychotropics and educate the team on signs and dangers of abuse. I loved that project because I didn’t realize how serious the problem was until I started looking at studies that focused on ED visits related to drug abuse and the numbers saddened me. I was happy to educate the team on ways to avoid abuse when working with injured workers. The second project was on Prescription Drug Monitoring Programs (PDMP) where we had to create a document and a presentation educating the team on the different PDMPs around the country and their different requirements. It was interesting to see how each state monitors patients and how they approach the opioid epidemic.

Overall, this was a great rotation. I didn’t have any managed care experience before coming in so I’m thankful for this experience! The team was very welcoming and open to questions and I had a wonderful co-intern that I connected with so well. The best part about this rotation is that I l learned so much and felt like I was making a difference with each IME, UR, and project that I completed on this rotation.