PayerIQ
Production
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Tier 3NDRegional

Community Health Options of North Dakota

Monitor & nurture — quarterly touchpoints + data sharing

Composite
56.3
Rank
#174
Members
3.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
46
+11.5
Lives
20%
70
+14.0
Geography
20%
68
+13.6
Restrictions
15%
36
+5.4
Relationship
10%
61
+6.1
Financials
10%
57
+5.7
Composite Score56.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 11.5 + 14.0 + 13.6 + 5.4 + 6.1 + 5.7 = 56.3
Intelligence

Qualitative intelligence

Members
3.3M
Drug spend
$0.9B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
26 days
Strategic notes

Data-sharing agreement pending legal review; delay contracting until finalized

Peer set

Closest peers in Regional

Tufts Health Plan of Tennessee
TN · Tier 3
56.8
+0.5
Rocky Mountain Health Plans of North Dakota
ND · Tier 3
55.6
-0.7
Sharp Health Plan of Arkansas
AR · Tier 3
57.4
+1.1
CareFirst of Ohio
OH · Tier 3
57.8
+1.5
Johns Hopkins Health Plans of Missouri
MO · Tier 2
58.2
+1.9
Playbook · Tier 3

Engagement timeline

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