PayerIQ
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Tier 4MIMedicare Advantage

Humana Gold Plus PPO

Deprioritize — minimal contact + revisit annually

Composite
44.9
Rank
#236
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
38
+9.5
Lives
20%
58
+11.6
Geography
20%
28
+5.6
Restrictions
15%
26
+3.9
Relationship
10%
65
+6.5
Financials
10%
78
+7.8
Composite Score44.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 9.5 + 11.6 + 5.6 + 3.9 + 6.5 + 7.8 = 44.9
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$1.6B
Formulary
4-tier
PA / RA level
Low
Biosimilar policy
Case-by-case review
Avg reimbursement
90 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in Medicare Advantage

Wellcare Medicare Advantage
DC · Tier 3
46.5
+1.6
Humana Gold Plus
ME · Tier 3
47.8
+2.9
Bright Health
MS · Tier 3
50.5
+5.6
Highmark Freedom Blue
ND · Tier 3
57.7
+12.8
Humana Gold Plus Health Plan
OH · Tier 4
29.5
-15.4
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier