PayerIQ
Production
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Tier 2WVRegional

Scott and White Health Plan of West Virginia

Active pursuit — access summits + value dossier

Composite
67.7
Rank
#51
Members
4.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
73
+18.3
Lives
20%
99
+19.8
Geography
20%
68
+13.6
Restrictions
15%
62
+9.3
Relationship
10%
57
+5.7
Financials
10%
10
+1.0
Composite Score67.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 18.3 + 19.8 + 13.6 + 9.3 + 5.7 + 1.0 = 67.7
Intelligence

Qualitative intelligence

Members
4.7M
Drug spend
$1.2B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
68 days
Strategic notes

Patient advocacy partnerships in market; leverage for formulary narrative

Peer set

Closest peers in Regional

MedStar Health of Washington DC
DC · Tier 2
67.7
0.0
UCare of Alaska
AK · Tier 2
67.6
-0.1
SelectCare of Utah
UT · Tier 2
67.0
-0.6
FirstChoice of Illinois
IL · Tier 2
68.5
+0.8
MetroPlus Health Plan of Kansas
KS · Tier 2
66.5
-1.2
Playbook · Tier 2

Engagement timeline

Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review