PayerIQ
Production
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Tier 2MSMedicare Advantage

Cigna-HealthSpring

Active pursuit — access summits + value dossier

Composite
60.5
Rank
#124
Members
2.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
48
+12.0
Lives
20%
58
+11.6
Geography
20%
86
+17.2
Restrictions
15%
36
+5.4
Relationship
10%
64
+6.4
Financials
10%
79
+7.9
Composite Score60.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 12.0 + 11.6 + 17.2 + 5.4 + 6.4 + 7.9 = 60.5
Intelligence

Qualitative intelligence

Members
2.5M
Drug spend
$1.5B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
79 days
Strategic notes

Large dual-eligible population; PA/RA process requires clinical evidence package

Peer set

Closest peers in Medicare Advantage

United AARP MedicareComplete Managed Care
IL · Tier 2
62.4
+1.9
Humana Gold Plus HMO
GA · Tier 2
62.4
+1.9
United AARP MedicareComplete
KS · Tier 2
62.7
+2.2
InnovAge PACE
AK · Tier 2
63.0
+2.5
Blue Shield Medicare Advantage
AL · Tier 2
63.3
+2.8
Playbook · Tier 2

Engagement timeline

Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review