PayerIQ
Production
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Tier 3MOBCBS

CareFirst BlueCross BlueShield

Monitor & nurture — quarterly touchpoints + data sharing

Composite
57.6
Rank
#160
Members
4.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
96
+24.0
Lives
20%
47
+9.4
Geography
20%
60
+12.0
Restrictions
15%
12
+1.8
Relationship
10%
71
+7.1
Financials
10%
33
+3.3
Composite Score57.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 24.0 + 9.4 + 12.0 + 1.8 + 7.1 + 3.3 = 57.6
Intelligence

Qualitative intelligence

Members
4.0M
Drug spend
$1.6B
Formulary
6-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
29 days
Strategic notes

Strong legacy relationship with regional medical director; preferred placement feasible

Peer set

Closest peers in BCBS

Arkansas Blue Cross and Blue Shield HMO
TX · Tier 3
56.8
-0.8
Blue Cross Blue Shield North Dakota
MA · Tier 2
58.5
+0.9
Anthem Blue Cross Blue Shield New Hampshire
TX · Tier 3
56.5
-1.1
Anthem HealthKeepers Virginia
AZ · Tier 2
58.9
+1.3
Medical Mutual of Ohio
MN · Tier 3
56.3
-1.4
Playbook · Tier 3

Engagement timeline

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