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Briana Botros is a consulting actuary with Miliman’s Chicago office. She joined the firm in 2014.
Briana has over eight 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 assisted multiple states in the Medicaid market with their Managed Care capitation rate development. She analyzes managed care encounters and financial data for completeness and accuracy, including conducting ongoing communications with health plans to uncover and resolve issues, examining the economic 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. She has also worked with pharmacy industry organizations to conduct research, particularly on Medicaid pharmacy.
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.
Case study: Health insurance microinsurance scheme, October 2017.