PayerIQ
Production
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Tier 2CARegional

WPS Health Solutions of California

Active pursuit — access summits + value dossier

Composite
66.2
Rank
#65
Members
2.8M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
48
+12.0
Lives
20%
54
+10.8
Geography
20%
98
+19.6
Restrictions
15%
54
+8.1
Relationship
10%
66
+6.6
Financials
10%
91
+9.1
Composite Score66.2
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 12.0 + 10.8 + 19.6 + 8.1 + 6.6 + 9.1 = 66.2
Intelligence

Qualitative intelligence

Members
2.8M
Drug spend
$0.8B
Formulary
3-tier
PA / RA level
Very High
Biosimilar policy
No policy defined
Avg reimbursement
58 days
Strategic notes

BCBS plan with regional flexibility; negotiation via BlueCard network possible

Peer set

Closest peers in Regional

HarmonyCare of Virginia
VA · Tier 2
66.2
-0.0
Crystal Run Health Plan of Illinois
IL · Tier 2
66.0
-0.2
MetroPlus Health Plan of Kansas
KS · Tier 2
66.5
+0.3
SelectCare of Utah
UT · Tier 2
67.0
+0.8
UCare of Alaska
AK · Tier 2
67.6
+1.4
Playbook · Tier 2

Engagement timeline

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