PayerIQ
Production
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Tier 2NHCommercial

CareOregon

Active pursuit — access summits + value dossier

Composite
67.2
Rank
#59
Members
2.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
66
+16.5
Lives
20%
71
+14.2
Geography
20%
58
+11.6
Restrictions
15%
81
+12.2
Relationship
10%
84
+8.4
Financials
10%
43
+4.3
Composite Score67.2
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.5 + 14.2 + 11.6 + 12.2 + 8.4 + 4.3 = 67.2
Intelligence

Qualitative intelligence

Members
2.4M
Drug spend
$0.5B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Preferred substitution
Avg reimbursement
36 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in Commercial

Hennepin Health
ND · Tier 2
67.3
+0.1
CareOregon Managed Care
DC · Tier 2
67.3
+0.1
Paramount Health Care
MA · Tier 2
68.9
+1.8
UCare
IA · Tier 2
70.5
+3.3
MDwise HMO
HI · Tier 2
63.4
-3.8
Playbook · Tier 2

Engagement timeline

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