PayerIQ
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Tier 2PAMedicare Advantage

Senior Whole Health

Active pursuit — access summits + value dossier

Composite
64.6
Rank
#80
Members
3.8M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
62
+15.5
Lives
20%
86
+17.2
Geography
20%
63
+12.6
Restrictions
15%
14
+2.1
Relationship
10%
77
+7.7
Financials
10%
95
+9.5
Composite Score64.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.5 + 17.2 + 12.6 + 2.1 + 7.7 + 9.5 = 64.6
Intelligence

Qualitative intelligence

Members
3.8M
Drug spend
$1.8B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Case-by-case review
Avg reimbursement
27 days
Strategic notes

Outperforms nationals in local market; key state champion opportunity

Peer set

Closest peers in Medicare Advantage

Aetna Medicare Select
AR · Tier 2
64.3
-0.3
Commonwealth Care Alliance
AZ · Tier 2
63.9
-0.7
Alignment Healthcare
IA · Tier 2
65.6
+1.0
Blue Shield Medicare Advantage
AL · Tier 2
63.3
-1.3
InnovAge PACE
AK · Tier 2
63.0
-1.6
Playbook · Tier 2

Engagement timeline

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