PayerIQ
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Tier 3OHRegional

CareFirst of Ohio

Monitor & nurture — quarterly touchpoints + data sharing

Composite
57.8
Rank
#158
Members
3.9M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
22
+5.5
Lives
20%
71
+14.2
Geography
20%
80
+16.0
Restrictions
15%
78
+11.7
Relationship
10%
42
+4.2
Financials
10%
62
+6.2
Composite Score57.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 5.5 + 14.2 + 16.0 + 11.7 + 4.2 + 6.2 = 57.8
Intelligence

Qualitative intelligence

Members
3.9M
Drug spend
$1.0B
Formulary
2-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
46 days
Strategic notes

Large covered lives base; formulary team open to outcomes-based contracts

Peer set

Closest peers in Regional

Sharp Health Plan of Arkansas
AR · Tier 3
57.4
-0.4
Johns Hopkins Health Plans of Missouri
MO · Tier 2
58.2
+0.4
SelectCare of New York
NY · Tier 2
58.3
+0.5
Arkansas Blue Cross of Oklahoma
OK · Tier 2
58.5
+0.8
Tufts Health Plan of New York
NY · Tier 2
58.8
+1.0
Playbook · Tier 3

Engagement timeline

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