PayerIQ
Production
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Tier 2NVRegional

HealthNew England of Nevada

Active pursuit — access summits + value dossier

Composite
64.5
Rank
#81
Members
2.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
66
+16.5
Lives
20%
45
+9.0
Geography
20%
77
+15.4
Restrictions
15%
48
+7.2
Relationship
10%
72
+7.2
Financials
10%
92
+9.2
Composite Score64.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.5 + 9.0 + 15.4 + 7.2 + 7.2 + 9.2 = 64.5
Intelligence

Qualitative intelligence

Members
2.2M
Drug spend
$0.7B
Formulary
5-tier
PA / RA level
Moderate
Biosimilar policy
Case-by-case review
Avg reimbursement
44 days
Strategic notes

Recent merger with regional system creates expanded formulary committee access

Peer set

Closest peers in Regional

Paramount Health Care of New Mexico
NM · Tier 2
64.7
+0.2
HarmonyCare of California
CA · Tier 2
64.8
+0.3
GuildNet of Tennessee
TN · Tier 2
63.0
-1.5
Crystal Run Health Plan of Illinois
IL · Tier 2
66.0
+1.5
HarmonyCare of Virginia
VA · Tier 2
66.2
+1.7
Playbook · Tier 2

Engagement timeline

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