PayerIQ
Production
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Tier 1MARegional

CareFirst of Massachusetts

Priority engagement — executive meetings + contract acceleration

Composite
77.1
Rank
#6
Members
4.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
97
+24.3
Lives
20%
84
+16.8
Geography
20%
100
+20.0
Restrictions
15%
37
+5.5
Relationship
10%
48
+4.8
Financials
10%
57
+5.7
Composite Score77.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 24.3 + 16.8 + 20.0 + 5.5 + 4.8 + 5.7 = 77.1
Intelligence

Qualitative intelligence

Members
4.4M
Drug spend
$1.2B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
No policy defined
Avg reimbursement
44 days
Strategic notes

Executive sponsor identified at VP of Pharmacy level; schedule quarterly touchpoint

Peer set

Closest peers in Regional

Sunshine Health of South Carolina
SC · Tier 1
76.7
-0.4
Denver Health Medical Plan of Minnesota
MN · Tier 1
79.1
+2.0
Providence Health of Connecticut
CT · Tier 1
72.7
-4.4
ConnectiCare of North Carolina
NC · Tier 2
70.9
-6.2
Dean Health Plan of Mississippi
MS · Tier 2
69.8
-7.3
Playbook · Tier 1

Engagement timeline

Week 1
Executive sponsor outreach · contract review
Week 2
Account team alignment · data sharing MoU
Week 4
Strategic roadmap session
Quarterly
C-suite QBR · joint planning