PayerIQ
Production
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Tier 2WYMedicare Advantage

Imperial Health Holdings

Active pursuit — access summits + value dossier

Composite
68.7
Rank
#45
Members
3.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
80
+20.0
Lives
20%
81
+16.2
Geography
20%
63
+12.6
Restrictions
15%
27
+4.0
Relationship
10%
88
+8.8
Financials
10%
70
+7.0
Composite Score68.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 20.0 + 16.2 + 12.6 + 4.0 + 8.8 + 7.0 = 68.7
Intelligence

Qualitative intelligence

Members
3.6M
Drug spend
$2.2B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
88 days
Strategic notes

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

Peer set

Closest peers in Medicare Advantage

AARP Medicare Complete
TX · Tier 2
68.7
0.0
Cigna-HealthSpring PPO
DE · Tier 2
69.5
+0.9
Imperial Health Holdings HMO
GA · Tier 2
70.3
+1.7
Friday Health Plans
CA · Tier 2
70.5
+1.9
Clover Health
NY · Tier 2
71.0
+2.4
Playbook · Tier 2

Engagement timeline

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