PayerIQ
Production
Back to universe
Tier 3MTRegional

Denver Health Medical Plan of Montana

Monitor & nurture — quarterly touchpoints + data sharing

Composite
46.0
Rank
#230
Members
3.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
38
+9.5
Lives
20%
56
+11.2
Geography
20%
55
+11.0
Restrictions
15%
29
+4.3
Relationship
10%
60
+6.0
Financials
10%
40
+4.0
Composite Score46.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 9.5 + 11.2 + 11.0 + 4.3 + 6.0 + 4.0 = 46.0
Intelligence

Qualitative intelligence

Members
3.3M
Drug spend
$0.9B
Formulary
3-tier
PA / RA level
Low
Biosimilar policy
Step therapy required
Avg reimbursement
94 days
Strategic notes

Restrictive formulary; outcomes-based arrangement may unlock Tier 2 placement

Peer set

Closest peers in Regional

GuildNet of Virginia
VA · Tier 4
45.9
-0.1
Priority Health of New York
NY · Tier 3
46.3
+0.3
Group Health of Delaware
DE · Tier 3
46.5
+0.4
Tufts Health Plan of Texas
TX · Tier 4
45.1
-0.9
Oscar Health of Oklahoma
OK · Tier 3
47.4
+1.4
Playbook · Tier 3

Engagement timeline

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