PayerIQ
Production
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Tier 2DENational

Mountain Health

Active pursuit — access summits + value dossier

Composite
65.4
Rank
#75
Members
27.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
54
+10.8
Geography
20%
71
+14.2
Restrictions
15%
10
+1.5
Relationship
10%
77
+7.7
Financials
10%
62
+6.2
Composite Score65.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 10.8 + 14.2 + 1.5 + 7.7 + 6.2 = 65.4
Intelligence

Qualitative intelligence

Members
27.2M
Drug spend
$10.6B
Formulary
3-tier
PA / RA level
Low
Biosimilar policy
Step therapy required
Avg reimbursement
28 days
Strategic notes

Recent merger with regional system creates expanded formulary committee access

Peer set

Closest peers in National

CareFirst
OR · Tier 2
65.3
-0.1
Capital BlueCross
GA · Tier 2
65.7
+0.3
Harvard Pilgrim
NH · Tier 2
65.8
+0.4
Harvard Pilgrim Health Plan
VT · Tier 2
66.0
+0.6
Inland Empire Health Plan
DE · Tier 2
66.8
+1.3
Playbook · Tier 2

Engagement timeline

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