PayerIQ
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Tier 3MSMedicare Advantage

Bright Health

Monitor & nurture — quarterly touchpoints + data sharing

Composite
50.5
Rank
#205
Members
3.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
39
+9.8
Lives
20%
79
+15.8
Geography
20%
36
+7.2
Restrictions
15%
34
+5.1
Relationship
10%
36
+3.6
Financials
10%
90
+9.0
Composite Score50.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 9.8 + 15.8 + 7.2 + 5.1 + 3.6 + 9.0 = 50.5
Intelligence

Qualitative intelligence

Members
3.3M
Drug spend
$1.9B
Formulary
5-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
23 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in Medicare Advantage

Humana Gold Plus
ME · Tier 3
47.8
-2.7
Wellcare Medicare Advantage
DC · Tier 3
46.5
-4.0
Humana Gold Plus PPO
MI · Tier 4
44.9
-5.6
Highmark Freedom Blue
ND · Tier 3
57.7
+7.3
Cigna-HealthSpring
MS · Tier 2
60.5
+10.0
Playbook · Tier 3

Engagement timeline

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