PayerIQ
Production
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Tier 3DERegional

HarmonyCare of Delaware

Monitor & nurture — quarterly touchpoints + data sharing

Composite
47.6
Rank
#220
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
57
+14.3
Lives
20%
44
+8.8
Geography
20%
44
+8.8
Restrictions
15%
28
+4.2
Relationship
10%
50
+5.0
Financials
10%
66
+6.6
Composite Score47.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 14.3 + 8.8 + 8.8 + 4.2 + 5.0 + 6.6 = 47.6
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$0.7B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Mandatory substitution
Avg reimbursement
27 days
Strategic notes

Data-sharing agreement pending legal review; delay contracting until finalized

Peer set

Closest peers in Regional

New Mexico Health Connections of Washington
WA · Tier 3
47.8
+0.1
Oscar Health of Oklahoma
OK · Tier 3
47.4
-0.3
Premera Blue Cross of Louisiana
LA · Tier 3
48.0
+0.4
Tufts Health Plan of Connecticut
CT · Tier 3
48.7
+1.1
New Mexico Health Connections of Kansas
KS · Tier 3
48.8
+1.1
Playbook · Tier 3

Engagement timeline

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