PayerIQ
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Tier 3VTMedicaid

Community Care Alliance Vermont Health Plan

Monitor & nurture — quarterly touchpoints + data sharing

Composite
55.8
Rank
#181
Members
6.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
69
+17.3
Lives
20%
37
+7.4
Geography
20%
63
+12.6
Restrictions
15%
43
+6.5
Relationship
10%
58
+5.8
Financials
10%
63
+6.3
Composite Score55.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 17.3 + 7.4 + 12.6 + 6.5 + 5.8 + 6.3 = 55.8
Intelligence

Qualitative intelligence

Members
6.2M
Drug spend
$1.2B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Case-by-case review
Avg reimbursement
60 days
Strategic notes

Strong balance sheet; specialty pipeline access discussion underway

Peer set

Closest peers in Medicaid

New Mexico Medicaid Health Plan
NM · Tier 3
55.9
+0.1
Meridian Health Plan of Louisiana
LA · Tier 3
56.0
+0.3
Medicaid Managed Care Hawaii
HI · Tier 3
56.4
+0.6
Molina Medicaid Iowa
IA · Tier 3
56.5
+0.7
Cenpatico California
CA · Tier 3
57.5
+1.7
Playbook · Tier 3

Engagement timeline

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