PayerIQ
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Tier 3WYRegional

Fallon Health of Wyoming

Monitor & nurture — quarterly touchpoints + data sharing

Composite
51.3
Rank
#201
Members
2.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
67
+16.8
Lives
20%
41
+8.2
Geography
20%
44
+8.8
Restrictions
15%
66
+9.9
Relationship
10%
38
+3.8
Financials
10%
38
+3.8
Composite Score51.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.8 + 8.2 + 8.8 + 9.9 + 3.8 + 3.8 = 51.3
Intelligence

Qualitative intelligence

Members
2.2M
Drug spend
$0.5B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
86 days
Strategic notes

Strong legacy relationship with regional medical director; preferred placement feasible

Peer set

Closest peers in Regional

SilverSummit Healthplan of New Mexico
NM · Tier 3
52.0
+0.8
Paramount Health Care of Oklahoma
OK · Tier 3
52.3
+1.0
Dean Health Plan of Georgia
GA · Tier 3
52.3
+1.0
New Mexico Health Connections of Wyoming
WY · Tier 3
49.9
-1.4
Cherokee Health Systems of New Jersey
NJ · Tier 3
53.4
+2.1
Playbook · Tier 3

Engagement timeline

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