PayerIQ
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Tier 3WIMedicaid

Wisconsin Community Health Alliance

Monitor & nurture — quarterly touchpoints + data sharing

Composite
47.1
Rank
#223
Members
8.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
30
+7.5
Lives
20%
62
+12.4
Geography
20%
65
+13.0
Restrictions
15%
44
+6.6
Relationship
10%
27
+2.7
Financials
10%
49
+4.9
Composite Score47.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 7.5 + 12.4 + 13.0 + 6.6 + 2.7 + 4.9 = 47.1
Intelligence

Qualitative intelligence

Members
8.7M
Drug spend
$1.9B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Case-by-case review
Avg reimbursement
49 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in Medicaid

Cenpatico Michigan
MI · Tier 3
47.0
-0.1
Minnesota Medicaid Health Plan
MN · Tier 3
46.1
-1.0
Molina Medicaid Louisiana
LA · Tier 4
45.7
-1.4
WellCare of Texas
TX · Tier 3
48.8
+1.6
WellCare of Florida
FL · Tier 4
45.4
-1.7
Playbook · Tier 3

Engagement timeline

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