PayerIQ
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Tier 4OHMedicare Advantage

Humana Gold Plus Health Plan

Deprioritize — minimal contact + revisit annually

Composite
29.5
Rank
#250
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
10
+2.5
Lives
20%
55
+11.0
Geography
20%
23
+4.6
Restrictions
15%
10
+1.5
Relationship
10%
41
+4.1
Financials
10%
58
+5.8
Composite Score29.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 2.5 + 11.0 + 4.6 + 1.5 + 4.1 + 5.8 = 29.5
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$1.3B
Formulary
6-tier
PA / RA level
Low
Biosimilar policy
Preferred substitution
Avg reimbursement
73 days
Strategic notes

Patient advocacy partnerships in market; leverage for formulary narrative

Peer set

Closest peers in Medicare Advantage

Humana Gold Plus PPO
MI · Tier 4
44.9
+15.4
Wellcare Medicare Advantage
DC · Tier 3
46.5
+17.0
Humana Gold Plus
ME · Tier 3
47.8
+18.3
Bright Health
MS · Tier 3
50.5
+21.0
Highmark Freedom Blue
ND · Tier 3
57.7
+28.2
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier