PayerIQ
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Tier 2ALMedicare Advantage

Blue Shield Medicare Advantage

Active pursuit — access summits + value dossier

Composite
63.3
Rank
#90
Members
2.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
82
+20.5
Lives
20%
63
+12.6
Geography
20%
52
+10.4
Restrictions
15%
47
+7.0
Relationship
10%
27
+2.7
Financials
10%
100
+10.0
Composite Score63.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 20.5 + 12.6 + 10.4 + 7.0 + 2.7 + 10.0 = 63.3
Intelligence

Qualitative intelligence

Members
2.4M
Drug spend
$1.5B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
43 days
Strategic notes

BCBS plan with regional flexibility; negotiation via BlueCard network possible

Peer set

Closest peers in Medicare Advantage

InnovAge PACE
AK · Tier 2
63.0
-0.3
United AARP MedicareComplete
KS · Tier 2
62.7
-0.5
Commonwealth Care Alliance
AZ · Tier 2
63.9
+0.6
Humana Gold Plus HMO
GA · Tier 2
62.4
-0.9
United AARP MedicareComplete Managed Care
IL · Tier 2
62.4
-0.9
Playbook · Tier 2

Engagement timeline

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