PayerIQ
Production
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Tier 2DCRegional

MedStar Health of Washington DC

Active pursuit — access summits + value dossier

Composite
67.7
Rank
#53
Members
3.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
66
+16.5
Lives
20%
66
+13.2
Geography
20%
72
+14.4
Restrictions
15%
71
+10.7
Relationship
10%
73
+7.3
Financials
10%
56
+5.6
Composite Score67.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.5 + 13.2 + 14.4 + 10.7 + 7.3 + 5.6 = 67.7
Intelligence

Qualitative intelligence

Members
3.2M
Drug spend
$1.0B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
No policy defined
Avg reimbursement
88 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in Regional

Scott and White Health Plan of West Virginia
WV · Tier 2
67.7
0.0
UCare of Alaska
AK · Tier 2
67.6
-0.1
SelectCare of Utah
UT · Tier 2
67.0
-0.6
FirstChoice of Illinois
IL · Tier 2
68.5
+0.8
MetroPlus Health Plan of Kansas
KS · Tier 2
66.5
-1.2
Playbook · Tier 2

Engagement timeline

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