PayerIQ
Production
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Tier 3KSRegional

New Mexico Health Connections of Kansas

Monitor & nurture — quarterly touchpoints + data sharing

Composite
48.8
Rank
#213
Members
1.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
57
+14.3
Lives
20%
10
+2.0
Geography
20%
74
+14.8
Restrictions
15%
32
+4.8
Relationship
10%
75
+7.5
Financials
10%
54
+5.4
Composite Score48.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 14.3 + 2.0 + 14.8 + 4.8 + 7.5 + 5.4 = 48.8
Intelligence

Qualitative intelligence

Members
1.0M
Drug spend
$0.3B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
18 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in Regional

Tufts Health Plan of Connecticut
CT · Tier 3
48.7
-0.0
CareFirst of Kentucky
KY · Tier 3
49.0
+0.3
Premera Blue Cross of Louisiana
LA · Tier 3
48.0
-0.7
New Mexico Health Connections of Washington
WA · Tier 3
47.8
-1.0
HarmonyCare of Delaware
DE · Tier 3
47.6
-1.1
Playbook · Tier 3

Engagement timeline

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