PayerIQ
Production
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Tier 2IDRegional

Mountain Health of Idaho

Active pursuit — access summits + value dossier

Composite
59.3
Rank
#139
Members
5.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
62
+15.5
Lives
20%
100
+20.0
Geography
20%
73
+14.6
Restrictions
15%
19
+2.9
Relationship
10%
17
+1.7
Financials
10%
46
+4.6
Composite Score59.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.5 + 20.0 + 14.6 + 2.9 + 1.7 + 4.6 = 59.3
Intelligence

Qualitative intelligence

Members
5.3M
Drug spend
$1.4B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
No policy defined
Avg reimbursement
88 days
Strategic notes

Medicare Part D plan with stable formulary; step edit removal is key ask

Peer set

Closest peers in Regional

WellStar Health of New Hampshire
NH · Tier 2
59.4
+0.1
UPMC Health Plan of Nevada
NV · Tier 2
59.1
-0.1
Buckeye Health Plan of Texas
TX · Tier 2
59.5
+0.2
MedStar Health of Utah
UT · Tier 2
59.5
+0.2
Tufts Health Plan of New York
NY · Tier 2
58.8
-0.5
Playbook · Tier 2

Engagement timeline

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