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Health Watch

By Bolton July 6th, 2018

Health Watch

The June 2018 issue of Health Watch, the Society of Actuaries’ Health Section Newsletter, is now available at:  https://www.soa.org/sections/health/health-newsletter/.  You will note that Bolton Health Actuarial’s own JoAnn Bogolin is the newsletter editor and two friends of Bolton contributed articles to this issue, Dawn Motovidlak and John Adler.

 

Dawn Motovidlak, MSW, is president and CEO of BHS (formerly known as Business Health Services), a leading national provider of behavioral health and corporate well-being solutions. In her article, Dawn tackles the availability of treatment for three impactful trends rooted in mental health care: the rise in chronic conditions, opioid addiction and mass shootings. At the core of the treatment of these issues is the provider network available to members. Dawn makes a strong case for actuaries and other risk assessment individuals not taking for granted that payers have adequate networks to address the needs of their members, despite having met all regulatory requirements for those networks.

 

John Adler is a pharmacy benefit management RFP consultant with 24 years of experience in PBM consulting. In his article, John provides guidance in evaluating the results of proposals from pharmacy benefits managers (PBMs). Taking the reader through the exact challenges of evaluating proposals from multiple PBMs, John addresses the entire process starting with the initial claims request (e.g., when to allow National Drug Code substitutions) through overall net pricing (understanding the timing of savings).

 

Please take a second to look through this publication and contact JoAnn Bogolin at JBogolin@BoltonHealth.com if you would like to contribute to a future issue!