PayerIQ
Production
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Tier 3CACommercial

PreferredOne PPO

Monitor & nurture — quarterly touchpoints + data sharing

Composite
52.0
Rank
#199
Members
3.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
51
+12.8
Lives
20%
100
+20.0
Geography
20%
48
+9.6
Restrictions
15%
10
+1.5
Relationship
10%
50
+5.0
Financials
10%
31
+3.1
Composite Score52.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 12.8 + 20.0 + 9.6 + 1.5 + 5.0 + 3.1 = 52.0
Intelligence

Qualitative intelligence

Members
3.3M
Drug spend
$0.7B
Formulary
2-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
26 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in Commercial

Crystal Run Health Plan
ID · Tier 3
52.9
+0.9
Tufts Health Plan
WA · Tier 3
50.8
-1.2
UPMC Health Plan
AK · Tier 3
49.6
-2.3
SilverSummit Healthplan
MD · Tier 3
54.5
+2.5
ConnectiCare
DE · Tier 3
54.7
+2.8
Playbook · Tier 3

Engagement timeline

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