PayerIQ
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Tier 2CANational

Dean Health Plan

Active pursuit — access summits + value dossier

Composite
61.6
Rank
#111
Members
29.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
96
+24.0
Lives
20%
60
+12.0
Geography
20%
66
+13.2
Restrictions
15%
10
+1.5
Relationship
10%
23
+2.3
Financials
10%
86
+8.6
Composite Score61.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 24.0 + 12.0 + 13.2 + 1.5 + 2.3 + 8.6 = 61.6
Intelligence

Qualitative intelligence

Members
29.6M
Drug spend
$10.6B
Formulary
5-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
68 days
Strategic notes

CMS Star Rating above 4.0; quality bonus payments create room for contract flexibility

Peer set

Closest peers in National

WellCare Health Plans
CO · Tier 2
61.8
+0.1
Humana
TN · Tier 2
61.9
+0.3
MetroPlus Health Plan
KY · Tier 2
62.0
+0.4
Independence Blue Cross Managed Care
NE · Tier 2
62.1
+0.5
Humana Insurance
NC · Tier 2
61.1
-0.5
Playbook · Tier 2

Engagement timeline

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