PayerIQ
Production
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Tier 4KYRegional

Oscar Health of Kentucky

Deprioritize — minimal contact + revisit annually

Composite
42.4
Rank
#241
Members
2.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
27
+6.8
Lives
20%
37
+7.4
Geography
20%
44
+8.8
Restrictions
15%
46
+6.9
Relationship
10%
25
+2.5
Financials
10%
100
+10.0
Composite Score42.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 6.8 + 7.4 + 8.8 + 6.9 + 2.5 + 10.0 = 42.4
Intelligence

Qualitative intelligence

Members
2.2M
Drug spend
$0.7B
Formulary
6-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
68 days
Strategic notes

Large covered lives base; formulary team open to outcomes-based contracts

Peer set

Closest peers in Regional

UCare of Colorado
CO · Tier 4
42.4
0.0
Capital Health Plan of South Carolina
SC · Tier 4
41.6
-0.7
Physicians Health Plan of Maryland
MD · Tier 4
43.1
+0.8
CareFirst of Wisconsin
WI · Tier 4
40.4
-2.0
Tufts Health Plan of Texas
TX · Tier 4
45.1
+2.8
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier