PayerIQ
Production
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Tier 3DECommercial

ConnectiCare

Monitor & nurture — quarterly touchpoints + data sharing

Composite
54.7
Rank
#183
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
58
+14.5
Lives
20%
67
+13.4
Geography
20%
47
+9.4
Restrictions
15%
48
+7.2
Relationship
10%
22
+2.2
Financials
10%
80
+8.0
Composite Score54.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 14.5 + 13.4 + 9.4 + 7.2 + 2.2 + 8.0 = 54.7
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$0.8B
Formulary
2-tier
PA / RA level
Very High
Biosimilar policy
Step therapy required
Avg reimbursement
93 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in Commercial

SilverSummit Healthplan
MD · Tier 3
54.5
-0.3
Excellus BlueCross BlueShield
MS · Tier 3
56.0
+1.3
Crystal Run Health Plan
ID · Tier 3
52.9
-1.8
Sutter Health Plus
OH · Tier 3
57.2
+2.5
PreferredOne PPO
CA · Tier 3
52.0
-2.8
Playbook · Tier 3

Engagement timeline

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