PayerIQ
Production
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Tier 3WICommercial

Sunshine Health

Monitor & nurture — quarterly touchpoints + data sharing

Composite
46.8
Rank
#225
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
52
+13.0
Lives
20%
71
+14.2
Geography
20%
31
+6.2
Restrictions
15%
39
+5.8
Relationship
10%
65
+6.5
Financials
10%
10
+1.0
Composite Score46.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 13.0 + 14.2 + 6.2 + 5.8 + 6.5 + 1.0 = 46.8
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$0.8B
Formulary
5-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
19 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in Commercial

Excellus BlueCross BlueShield HMO
TX · Tier 3
47.4
+0.6
MDwise
AK · Tier 4
45.5
-1.3
WellStar Health
WI · Tier 3
48.6
+1.9
UPMC Health Plan
AK · Tier 3
49.6
+2.9
Tufts Health Plan
WA · Tier 3
50.8
+4.0
Playbook · Tier 3

Engagement timeline

Week 2
Account manager check-in
Bi-annually
Formulary monitoring report