PayerIQ
Production
Back to universe
Tier 2DENational

Inland Empire Health Plan

Active pursuit — access summits + value dossier

Composite
66.8
Rank
#63
Members
21.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
50
+10.0
Geography
20%
69
+13.8
Restrictions
15%
51
+7.6
Relationship
10%
60
+6.0
Financials
10%
43
+4.3
Composite Score66.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 10.0 + 13.8 + 7.6 + 6.0 + 4.3 = 66.8
Intelligence

Qualitative intelligence

Members
21.1M
Drug spend
$8.4B
Formulary
6-tier
PA / RA level
Low
Biosimilar policy
Mandatory substitution
Avg reimbursement
91 days
Strategic notes

Strong balance sheet; specialty pipeline access discussion underway

Peer set

Closest peers in National

Harvard Pilgrim Health Plan
VT · Tier 2
66.0
-0.7
Harvard Pilgrim
NH · Tier 2
65.8
-0.9
Capital BlueCross
GA · Tier 2
65.7
-1.1
Mountain Health
DE · Tier 2
65.4
-1.3
CareFirst
OR · Tier 2
65.3
-1.4
Playbook · Tier 2

Engagement timeline

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