PayerIQ
Production
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Tier 3AKCommercial

UPMC Health Plan

Monitor & nurture — quarterly touchpoints + data sharing

Composite
49.6
Rank
#209
Members
2.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
60
+15.0
Lives
20%
59
+11.8
Geography
20%
39
+7.8
Restrictions
15%
35
+5.3
Relationship
10%
27
+2.7
Financials
10%
71
+7.1
Composite Score49.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.0 + 11.8 + 7.8 + 5.3 + 2.7 + 7.1 = 49.6
Intelligence

Qualitative intelligence

Members
2.4M
Drug spend
$0.6B
Formulary
2-tier
PA / RA level
Very High
Biosimilar policy
No policy defined
Avg reimbursement
50 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in Commercial

WellStar Health
WI · Tier 3
48.6
-1.0
Tufts Health Plan
WA · Tier 3
50.8
+1.1
Excellus BlueCross BlueShield HMO
TX · Tier 3
47.4
-2.3
PreferredOne PPO
CA · Tier 3
52.0
+2.3
Sunshine Health
WI · Tier 3
46.8
-2.9
Playbook · Tier 3

Engagement timeline

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