Briana Botros

Briana has 10 years of actuarial experience in several areas of healthcare. She works with various entities, including state government agencies, Managed Care Organizations (MCOs), pharmacy industry organizations, pharmacy benefit managers (PBMs), employers, and employer coalitions. Her expertise includes developing Medicaid-managed care capitation rates and assisting employers and employer coalitions in analyzing pharmacy contracting. She also has broad experience in research and model building, developing client-facing and managing tools.

Briana has extensive experience in the analysis and interpretation of large healthcare claims data. She has worked with various industry organizations to conduct research that drives strategic decision making related to changes in the legislative and regulatory environments.

In the Medicaid market, Briana is one of the lead consultants in managed Medicaid capitation rate development, risk adjustment, and financial modelling for multiple states. These states serve a wide variety of populations and covered benefits. This work has also included strategic assistance around program design, rate negotiations and contracting, and Medicaid waiver development. Her experience includes developing Medicaid managed care capitation rates; analyzing managed care encounter and financial data for completeness and accuracy, including ongoing communication with health plans to uncover and solve issues; analyzing the financial impact of legislative changes on state Medicaid programs; and preparing analyses to interface with regulators and MCOs in their reviews of Medicaid managed care rate filings.

Briana’s work with pharmacy benefits has focused on assisting clients in evaluating PBM proposals / contracts during procurements, renewals, and market checks. In addition, she has assessed and provided guidance on PBM programs for her clients. Additionally, Briana has experience with rate filings in the commercial market. She has also assisted with pricing and product development for Health Microinsurance products for a country with low levels of health insurance penetration.