PayerIQ
Production
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Tier 2ILRegional

Crystal Run Health Plan of Illinois

Active pursuit — access summits + value dossier

Composite
66.0
Rank
#69
Members
3.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
61
+15.3
Lives
20%
74
+14.8
Geography
20%
94
+18.8
Restrictions
15%
23
+3.4
Relationship
10%
68
+6.8
Financials
10%
69
+6.9
Composite Score66.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.3 + 14.8 + 18.8 + 3.4 + 6.8 + 6.9 = 66.0
Intelligence

Qualitative intelligence

Members
3.6M
Drug spend
$1.2B
Formulary
3-tier
PA / RA level
Low
Biosimilar policy
Case-by-case review
Avg reimbursement
61 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in Regional

HarmonyCare of Virginia
VA · Tier 2
66.2
+0.2
WPS Health Solutions of California
CA · Tier 2
66.2
+0.2
MetroPlus Health Plan of Kansas
KS · Tier 2
66.5
+0.5
SelectCare of Utah
UT · Tier 2
67.0
+1.0
HarmonyCare of California
CA · Tier 2
64.8
-1.2
Playbook · Tier 2

Engagement timeline

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