PayerIQ
Production
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Tier 2CARegional

HarmonyCare of California

Active pursuit — access summits + value dossier

Composite
64.8
Rank
#77
Members
3.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
47
+11.8
Lives
20%
67
+13.4
Geography
20%
79
+15.8
Restrictions
15%
57
+8.5
Relationship
10%
74
+7.4
Financials
10%
79
+7.9
Composite Score64.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 11.8 + 13.4 + 15.8 + 8.5 + 7.4 + 7.9 = 64.8
Intelligence

Qualitative intelligence

Members
3.5M
Drug spend
$0.9B
Formulary
5-tier
PA / RA level
Moderate
Biosimilar policy
Preferred substitution
Avg reimbursement
66 days
Strategic notes

Strong balance sheet; specialty pipeline access discussion underway

Peer set

Closest peers in Regional

Paramount Health Care of New Mexico
NM · Tier 2
64.7
-0.1
HealthNew England of Nevada
NV · Tier 2
64.5
-0.3
Crystal Run Health Plan of Illinois
IL · Tier 2
66.0
+1.2
HarmonyCare of Virginia
VA · Tier 2
66.2
+1.4
WPS Health Solutions of California
CA · Tier 2
66.2
+1.4
Playbook · Tier 2

Engagement timeline

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