PayerIQ
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Tier 3MTNational

Kaiser Permanente Insurance

Monitor & nurture — quarterly touchpoints + data sharing

Composite
57.1
Rank
#165
Members
25.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
52
+13.0
Lives
20%
60
+12.0
Geography
20%
56
+11.2
Restrictions
15%
44
+6.6
Relationship
10%
50
+5.0
Financials
10%
93
+9.3
Composite Score57.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 13.0 + 12.0 + 11.2 + 6.6 + 5.0 + 9.3 = 57.1
Intelligence

Qualitative intelligence

Members
25.1M
Drug spend
$10.5B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
28 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in National

Centene Corporation
GA · Tier 3
56.8
-0.3
Regence BlueCross BlueShield
MN · Tier 3
57.5
+0.4
Blue Cross Blue Shield Association
LA · Tier 2
58.2
+1.1
Independence Blue Cross
KS · Tier 3
54.3
-2.9
AmeriHealth
UT · Tier 3
54.1
-3.0
Playbook · Tier 3

Engagement timeline

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