PayerIQ
Production
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Tier 2DEMedicare Advantage

Cigna-HealthSpring PPO

Active pursuit — access summits + value dossier

Composite
69.5
Rank
#37
Members
3.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
52
+13.0
Lives
20%
68
+13.6
Geography
20%
85
+17.0
Restrictions
15%
47
+7.0
Relationship
10%
91
+9.1
Financials
10%
98
+9.8
Composite Score69.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 13.0 + 13.6 + 17.0 + 7.0 + 9.1 + 9.8 = 69.5
Intelligence

Qualitative intelligence

Members
3.0M
Drug spend
$1.4B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Mandatory substitution
Avg reimbursement
83 days
Strategic notes

BCBS plan with regional flexibility; negotiation via BlueCard network possible

Peer set

Closest peers in Medicare Advantage

Imperial Health Holdings HMO
GA · Tier 2
70.3
+0.8
AARP Medicare Complete
TX · Tier 2
68.7
-0.9
Imperial Health Holdings
WY · Tier 2
68.7
-0.9
Friday Health Plans
CA · Tier 2
70.5
+1.0
Clover Health
NY · Tier 2
71.0
+1.5
Playbook · Tier 2

Engagement timeline

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