PayerIQ
Production
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Tier 2MORegional

Johns Hopkins Health Plans of Missouri

Active pursuit — access summits + value dossier

Composite
58.2
Rank
#155
Members
2.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
64
+16.0
Lives
20%
43
+8.6
Geography
20%
58
+11.6
Restrictions
15%
44
+6.6
Relationship
10%
90
+9.0
Financials
10%
64
+6.4
Composite Score58.2
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.0 + 8.6 + 11.6 + 6.6 + 9.0 + 6.4 = 58.2
Intelligence

Qualitative intelligence

Members
2.4M
Drug spend
$0.6B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
25 days
Strategic notes

Competitive payer landscape in state; differentiation via HEOR data essential

Peer set

Closest peers in Regional

SelectCare of New York
NY · Tier 2
58.3
+0.1
Arkansas Blue Cross of Oklahoma
OK · Tier 2
58.5
+0.3
CareFirst of Ohio
OH · Tier 3
57.8
-0.4
Tufts Health Plan of New York
NY · Tier 2
58.8
+0.5
Sharp Health Plan of Arkansas
AR · Tier 3
57.4
-0.8
Playbook · Tier 2

Engagement timeline

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