PayerIQ
Production
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Tier 2CTRegional

EmblemHealth of Connecticut

Active pursuit — access summits + value dossier

Composite
60.0
Rank
#130
Members
4.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
76
+19.0
Lives
20%
84
+16.8
Geography
20%
31
+6.2
Restrictions
15%
35
+5.3
Relationship
10%
91
+9.1
Financials
10%
36
+3.6
Composite Score60.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 19.0 + 16.8 + 6.2 + 5.3 + 9.1 + 3.6 = 60.0
Intelligence

Qualitative intelligence

Members
4.0M
Drug spend
$1.4B
Formulary
2-tier
PA / RA level
Moderate
Biosimilar policy
Case-by-case review
Avg reimbursement
24 days
Strategic notes

Restrictive formulary; outcomes-based arrangement may unlock Tier 2 placement

Peer set

Closest peers in Regional

SCAN Health Plan of South Carolina
SC · Tier 2
60.3
+0.3
Gateway Health Plan of Maine
ME · Tier 2
60.4
+0.4
Florida Blue of South Dakota
SD · Tier 2
60.5
+0.5
Buckeye Health Plan of Texas
TX · Tier 2
59.5
-0.5
MedStar Health of Utah
UT · Tier 2
59.5
-0.5
Playbook · Tier 2

Engagement timeline

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