PayerIQ
Production
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Tier 3DERegional

Group Health of Delaware

Monitor & nurture — quarterly touchpoints + data sharing

Composite
46.5
Rank
#227
Members
3.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
45
+11.3
Lives
20%
57
+11.4
Geography
20%
65
+13.0
Restrictions
15%
12
+1.8
Relationship
10%
34
+3.4
Financials
10%
56
+5.6
Composite Score46.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 11.3 + 11.4 + 13.0 + 1.8 + 3.4 + 5.6 = 46.5
Intelligence

Qualitative intelligence

Members
3.0M
Drug spend
$0.9B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
54 days
Strategic notes

Executive sponsor identified at VP of Pharmacy level; schedule quarterly touchpoint

Peer set

Closest peers in Regional

Priority Health of New York
NY · Tier 3
46.3
-0.2
Denver Health Medical Plan of Montana
MT · Tier 3
46.0
-0.4
GuildNet of Virginia
VA · Tier 4
45.9
-0.6
Oscar Health of Oklahoma
OK · Tier 3
47.4
+0.9
HarmonyCare of Delaware
DE · Tier 3
47.6
+1.2
Playbook · Tier 3

Engagement timeline

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