PayerIQ
Production
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Tier 2NVRegional

UPMC Health Plan of Nevada

Active pursuit — access summits + value dossier

Composite
59.1
Rank
#141
Members
4.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
62
+15.5
Lives
20%
91
+18.2
Geography
20%
60
+12.0
Restrictions
15%
10
+1.5
Relationship
10%
56
+5.6
Financials
10%
63
+6.3
Composite Score59.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.5 + 18.2 + 12.0 + 1.5 + 5.6 + 6.3 = 59.1
Intelligence

Qualitative intelligence

Members
4.6M
Drug spend
$1.6B
Formulary
3-tier
PA / RA level
Very High
Biosimilar policy
Mandatory substitution
Avg reimbursement
44 days
Strategic notes

Strong legacy relationship with regional medical director; preferred placement feasible

Peer set

Closest peers in Regional

Mountain Health of Idaho
ID · Tier 2
59.3
+0.1
WellStar Health of New Hampshire
NH · Tier 2
59.4
+0.3
Tufts Health Plan of New York
NY · Tier 2
58.8
-0.4
Buckeye Health Plan of Texas
TX · Tier 2
59.5
+0.4
MedStar Health of Utah
UT · Tier 2
59.5
+0.4
Playbook · Tier 2

Engagement timeline

Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review