PayerIQ
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Tier 2IAMedicare Advantage

Alignment Healthcare

Active pursuit — access summits + value dossier

Composite
65.6
Rank
#72
Members
3.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
74
+18.5
Lives
20%
88
+17.6
Geography
20%
61
+12.2
Restrictions
15%
30
+4.5
Relationship
10%
65
+6.5
Financials
10%
63
+6.3
Composite Score65.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 18.5 + 17.6 + 12.2 + 4.5 + 6.5 + 6.3 = 65.6
Intelligence

Qualitative intelligence

Members
3.6M
Drug spend
$1.9B
Formulary
6-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
73 days
Strategic notes

CMS Star Rating above 4.0; quality bonus payments create room for contract flexibility

Peer set

Closest peers in Medicare Advantage

Senior Whole Health
PA · Tier 2
64.6
-1.0
Aetna Medicare Select
AR · Tier 2
64.3
-1.3
Commonwealth Care Alliance
AZ · Tier 2
63.9
-1.7
Blue Shield Medicare Advantage
AL · Tier 2
63.3
-2.3
InnovAge PACE
AK · Tier 2
63.0
-2.6
Playbook · Tier 2

Engagement timeline

Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review