PayerIQ
Production
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Tier 3NMBCBS

Blue Cross Blue Shield of Rhode Island

Monitor & nurture — quarterly touchpoints + data sharing

Composite
53.0
Rank
#193
Members
7.9M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
24
+6.0
Lives
20%
100
+20.0
Geography
20%
32
+6.4
Restrictions
15%
41
+6.1
Relationship
10%
100
+10.0
Financials
10%
44
+4.4
Composite Score53.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 6.0 + 20.0 + 6.4 + 6.1 + 10.0 + 4.4 = 53.0
Intelligence

Qualitative intelligence

Members
7.9M
Drug spend
$2.9B
Formulary
4-tier
PA / RA level
None
Biosimilar policy
No policy defined
Avg reimbursement
79 days
Strategic notes

Strong balance sheet; specialty pipeline access discussion underway

Peer set

Closest peers in BCBS

Regence BlueCross BlueShield Oregon
OR · Tier 3
53.8
+0.8
Blue Cross Blue Shield of Michigan
WV · Tier 3
54.6
+1.7
Blue Cross Blue Shield of Texas
NY · Tier 3
50.7
-2.3
Medical Mutual of Ohio
MN · Tier 3
56.3
+3.3
Anthem Blue Cross Blue Shield New Hampshire
TX · Tier 3
56.5
+3.5
Playbook · Tier 3

Engagement timeline

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