PayerIQ
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Tier 3MDCommercial

SilverSummit Healthplan

Monitor & nurture — quarterly touchpoints + data sharing

Composite
54.5
Rank
#185
Members
0.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
79
+19.8
Lives
20%
10
+2.0
Geography
20%
47
+9.4
Restrictions
15%
70
+10.5
Relationship
10%
40
+4.0
Financials
10%
88
+8.8
Composite Score54.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 19.8 + 2.0 + 9.4 + 10.5 + 4.0 + 8.8 = 54.5
Intelligence

Qualitative intelligence

Members
0.6M
Drug spend
$0.2B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
Preferred substitution
Avg reimbursement
45 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in Commercial

ConnectiCare
DE · Tier 3
54.7
+0.3
Excellus BlueCross BlueShield
MS · Tier 3
56.0
+1.5
Crystal Run Health Plan
ID · Tier 3
52.9
-1.6
PreferredOne PPO
CA · Tier 3
52.0
-2.5
Sutter Health Plus
OH · Tier 3
57.2
+2.8
Playbook · Tier 3

Engagement timeline

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