PayerIQ
Production
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Tier 3NDRegional

Rocky Mountain Health Plans of North Dakota

Monitor & nurture — quarterly touchpoints + data sharing

Composite
55.6
Rank
#182
Members
2.8M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
57
+14.3
Lives
20%
58
+11.6
Geography
20%
53
+10.6
Restrictions
15%
41
+6.1
Relationship
10%
69
+6.9
Financials
10%
61
+6.1
Composite Score55.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 14.3 + 11.6 + 10.6 + 6.1 + 6.9 + 6.1 = 55.6
Intelligence

Qualitative intelligence

Members
2.8M
Drug spend
$0.7B
Formulary
2-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
32 days
Strategic notes

Data-sharing agreement pending legal review; delay contracting until finalized

Peer set

Closest peers in Regional

Community Health Options of North Dakota
ND · Tier 3
56.3
+0.7
Tufts Health Plan of Tennessee
TN · Tier 3
56.8
+1.1
MedStar Health of Vermont
VT · Tier 3
54.1
-1.5
Sharp Health Plan of Arkansas
AR · Tier 3
57.4
+1.8
CareFirst of Ohio
OH · Tier 3
57.8
+2.2
Playbook · Tier 3

Engagement timeline

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