PayerIQ
Production
Back to universe
Tier 2HICommercial

MDwise HMO

Active pursuit — access summits + value dossier

Composite
63.4
Rank
#88
Members
2.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
69
+17.3
Lives
20%
69
+13.8
Geography
20%
47
+9.4
Restrictions
15%
69
+10.3
Relationship
10%
51
+5.1
Financials
10%
75
+7.5
Composite Score63.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 17.3 + 13.8 + 9.4 + 10.3 + 5.1 + 7.5 = 63.4
Intelligence

Qualitative intelligence

Members
2.4M
Drug spend
$0.5B
Formulary
5-tier
PA / RA level
None
Biosimilar policy
Preferred substitution
Avg reimbursement
90 days
Strategic notes

Prior collaboration on REMS program; account trust level high

Peer set

Closest peers in Commercial

Arkansas Blue Cross
OK · Tier 2
63.0
-0.4
Sunshine Health MCO
NH · Tier 2
61.2
-2.2
CareOregon
NH · Tier 2
67.2
+3.8
Hennepin Health
ND · Tier 2
67.3
+3.9
CareOregon Managed Care
DC · Tier 2
67.3
+3.9
Playbook · Tier 2

Engagement timeline

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