PayerIQ
Production
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Tier 3LABCBS

Blue Cross Blue Shield of Massachusetts

Monitor & nurture — quarterly touchpoints + data sharing

Composite
49.0
Rank
#211
Members
7.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
39
+9.8
Lives
20%
82
+16.4
Geography
20%
41
+8.2
Restrictions
15%
21
+3.1
Relationship
10%
75
+7.5
Financials
10%
40
+4.0
Composite Score49.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 9.8 + 16.4 + 8.2 + 3.1 + 7.5 + 4.0 = 49.0
Intelligence

Qualitative intelligence

Members
7.0M
Drug spend
$2.0B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
79 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in BCBS

Blue Cross Blue Shield of Texas
NY · Tier 3
50.7
+1.7
Blue Cross Blue Shield of Rhode Island
NM · Tier 3
53.0
+4.0
Regence BlueCross BlueShield Oregon
OR · Tier 3
53.8
+4.8
Blue Cross Blue Shield of Michigan
WV · Tier 3
54.6
+5.6
Medical Mutual of Ohio
MN · Tier 3
56.3
+7.3
Playbook · Tier 3

Engagement timeline

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