PayerIQ
Production
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Tier 3WYRegional

New Mexico Health Connections of Wyoming

Monitor & nurture — quarterly touchpoints + data sharing

Composite
49.9
Rank
#207
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
21
+5.3
Lives
20%
52
+10.4
Geography
20%
51
+10.2
Restrictions
15%
58
+8.7
Relationship
10%
100
+10.0
Financials
10%
53
+5.3
Composite Score49.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 5.3 + 10.4 + 10.2 + 8.7 + 10.0 + 5.3 = 49.9
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$0.6B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Case-by-case review
Avg reimbursement
38 days
Strategic notes

Medicare Part D plan with stable formulary; step edit removal is key ask

Peer set

Closest peers in Regional

CareFirst of Kentucky
KY · Tier 3
49.0
-0.9
New Mexico Health Connections of Kansas
KS · Tier 3
48.8
-1.1
Tufts Health Plan of Connecticut
CT · Tier 3
48.7
-1.1
Fallon Health of Wyoming
WY · Tier 3
51.3
+1.4
Premera Blue Cross of Louisiana
LA · Tier 3
48.0
-1.8
Playbook · Tier 3

Engagement timeline

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