PayerIQ
Production
Back to universe
Tier 3WARegional

New Mexico Health Connections of Washington

Monitor & nurture — quarterly touchpoints + data sharing

Composite
47.8
Rank
#219
Members
2.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
40
+10.0
Lives
20%
49
+9.8
Geography
20%
66
+13.2
Restrictions
15%
10
+1.5
Relationship
10%
50
+5.0
Financials
10%
83
+8.3
Composite Score47.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 10.0 + 9.8 + 13.2 + 1.5 + 5.0 + 8.3 = 47.8
Intelligence

Qualitative intelligence

Members
2.5M
Drug spend
$0.9B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Case-by-case review
Avg reimbursement
46 days
Strategic notes

Strong balance sheet; specialty pipeline access discussion underway

Peer set

Closest peers in Regional

HarmonyCare of Delaware
DE · Tier 3
47.6
-0.1
Premera Blue Cross of Louisiana
LA · Tier 3
48.0
+0.3
Oscar Health of Oklahoma
OK · Tier 3
47.4
-0.4
Tufts Health Plan of Connecticut
CT · Tier 3
48.7
+0.9
New Mexico Health Connections of Kansas
KS · Tier 3
48.8
+1.0
Playbook · Tier 3

Engagement timeline

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