PayerIQ
Production
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Tier 3NDMedicare Advantage

Highmark Freedom Blue

Monitor & nurture — quarterly touchpoints + data sharing

Composite
57.7
Rank
#159
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
64
+16.0
Lives
20%
53
+10.6
Geography
20%
68
+13.6
Restrictions
15%
38
+5.7
Relationship
10%
51
+5.1
Financials
10%
67
+6.7
Composite Score57.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.0 + 10.6 + 13.6 + 5.7 + 5.1 + 6.7 = 57.7
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$1.6B
Formulary
4-tier
PA / RA level
None
Biosimilar policy
Step therapy required
Avg reimbursement
31 days
Strategic notes

Patient advocacy partnerships in market; leverage for formulary narrative

Peer set

Closest peers in Medicare Advantage

Cigna-HealthSpring
MS · Tier 2
60.5
+2.8
United AARP MedicareComplete Managed Care
IL · Tier 2
62.4
+4.6
Humana Gold Plus HMO
GA · Tier 2
62.4
+4.7
United AARP MedicareComplete
KS · Tier 2
62.7
+5.0
InnovAge PACE
AK · Tier 2
63.0
+5.3
Playbook · Tier 3

Engagement timeline

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