PayerIQ
Production
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Tier 4VARegional

GuildNet of Virginia

Deprioritize — minimal contact + revisit annually

Composite
45.9
Rank
#231
Members
1.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
70
+17.5
Lives
20%
22
+4.4
Geography
20%
50
+10.0
Restrictions
15%
26
+3.9
Relationship
10%
59
+5.9
Financials
10%
42
+4.2
Composite Score45.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 17.5 + 4.4 + 10.0 + 3.9 + 5.9 + 4.2 = 45.9
Intelligence

Qualitative intelligence

Members
1.4M
Drug spend
$0.4B
Formulary
5-tier
PA / RA level
Moderate
Biosimilar policy
Case-by-case review
Avg reimbursement
30 days
Strategic notes

Strong balance sheet; specialty pipeline access discussion underway

Peer set

Closest peers in Regional

Denver Health Medical Plan of Montana
MT · Tier 3
46.0
+0.1
Priority Health of New York
NY · Tier 3
46.3
+0.4
Group Health of Delaware
DE · Tier 3
46.5
+0.6
Tufts Health Plan of Texas
TX · Tier 4
45.1
-0.8
Oscar Health of Oklahoma
OK · Tier 3
47.4
+1.5
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier