PayerIQ
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Tier 3MEMedicare Advantage

Humana Gold Plus

Monitor & nurture — quarterly touchpoints + data sharing

Composite
47.8
Rank
#218
Members
3.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
44
+11.0
Lives
20%
71
+14.2
Geography
20%
44
+8.8
Restrictions
15%
16
+2.4
Relationship
10%
51
+5.1
Financials
10%
63
+6.3
Composite Score47.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 11.0 + 14.2 + 8.8 + 2.4 + 5.1 + 6.3 = 47.8
Intelligence

Qualitative intelligence

Members
3.2M
Drug spend
$2.1B
Formulary
4-tier
PA / RA level
Low
Biosimilar policy
Step therapy required
Avg reimbursement
63 days
Strategic notes

Strong legacy relationship with regional medical director; preferred placement feasible

Peer set

Closest peers in Medicare Advantage

Wellcare Medicare Advantage
DC · Tier 3
46.5
-1.3
Bright Health
MS · Tier 3
50.5
+2.7
Humana Gold Plus PPO
MI · Tier 4
44.9
-2.9
Highmark Freedom Blue
ND · Tier 3
57.7
+9.9
Cigna-HealthSpring
MS · Tier 2
60.5
+12.7
Playbook · Tier 3

Engagement timeline

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