PayerIQ
Production
Back to universe
Tier 4SCRegional

Capital Health Plan of South Carolina

Deprioritize — minimal contact + revisit annually

Composite
41.6
Rank
#243
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
43
+10.8
Lives
20%
41
+8.2
Geography
20%
35
+7.0
Restrictions
15%
24
+3.6
Relationship
10%
59
+5.9
Financials
10%
62
+6.2
Composite Score41.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 10.8 + 8.2 + 7.0 + 3.6 + 5.9 + 6.2 = 41.6
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$0.8B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Mandatory substitution
Avg reimbursement
33 days
Strategic notes

CMS Star Rating above 4.0; quality bonus payments create room for contract flexibility

Peer set

Closest peers in Regional

Oscar Health of Kentucky
KY · Tier 4
42.4
+0.7
UCare of Colorado
CO · Tier 4
42.4
+0.7
CareFirst of Wisconsin
WI · Tier 4
40.4
-1.3
Physicians Health Plan of Maryland
MD · Tier 4
43.1
+1.5
Tufts Health Plan of Texas
TX · Tier 4
45.1
+3.5
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier