Briana has over seven 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 areas of expertise include developing Medicaid managed care capitation rates, assisting employers and employer coalitions analyzing pharmacy contracting. She also has broad experience with research and model building, developing client-facing tools, and tool management.
In the Medicaid market, Briana has assisted multiple states with their Managed Care capitation rate development, analyzing managed care encounter and financial data for completeness and accuracy, including conducting ongoing communications with health plans to uncover and resolve 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 evaluated and provided guidance on PBM programs for her clients. She also has worked with pharmacy industry organizations to conduct research, with a particular emphasis 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.
