PayerIQ
Production
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Tier 2SCBCBS

Hawaii Medical Service Association

Active pursuit — access summits + value dossier

Composite
67.5
Rank
#55
Members
5.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
66
+16.5
Lives
20%
57
+11.4
Geography
20%
65
+13.0
Restrictions
15%
63
+9.4
Relationship
10%
87
+8.7
Financials
10%
85
+8.5
Composite Score67.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.5 + 11.4 + 13.0 + 9.4 + 8.7 + 8.5 = 67.5
Intelligence

Qualitative intelligence

Members
5.0M
Drug spend
$1.6B
Formulary
6-tier
PA / RA level
Low
Biosimilar policy
Case-by-case review
Avg reimbursement
57 days
Strategic notes

Large covered lives base; formulary team open to outcomes-based contracts

Peer set

Closest peers in BCBS

Blue Cross Blue Shield of Rhode Island Health Plan
TN · Tier 2
67.7
+0.1
Anthem Blue Cross Blue Shield of Colorado
AK · Tier 2
67.8
+0.3
Blue Cross Blue Shield of Massachusetts Insurance
GA · Tier 2
68.0
+0.4
Florida Blue
ME · Tier 2
68.1
+0.5
Wellmark Blue Cross Blue Shield Iowa
WY · Tier 2
66.8
-0.8
Playbook · Tier 2

Engagement timeline

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