PayerIQ
Production
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Tier 3HINational

Northeast Health

Monitor & nurture — quarterly touchpoints + data sharing

Composite
50.4
Rank
#206
Members
23.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
74
+18.5
Lives
20%
50
+10.0
Geography
20%
26
+5.2
Restrictions
15%
40
+6.0
Relationship
10%
46
+4.6
Financials
10%
61
+6.1
Composite Score50.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 18.5 + 10.0 + 5.2 + 6.0 + 4.6 + 6.1 = 50.4
Intelligence

Qualitative intelligence

Members
23.7M
Drug spend
$9.8B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Case-by-case review
Avg reimbursement
54 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in National

HealthSpring
AR · Tier 3
54.0
+3.6
AmeriHealth
UT · Tier 3
54.1
+3.7
Independence Blue Cross
KS · Tier 3
54.3
+3.9
Kaiser Permanente
IN · Tier 4
44.3
-6.1
Centene Corporation
GA · Tier 3
56.8
+6.4
Playbook · Tier 3

Engagement timeline

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