PayerIQ
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Tier 2GAMedicare Advantage

Humana Gold Plus HMO

Active pursuit — access summits + value dossier

Composite
62.4
Rank
#99
Members
1.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
86
+21.5
Lives
20%
34
+6.8
Geography
20%
77
+15.4
Restrictions
15%
30
+4.5
Relationship
10%
66
+6.6
Financials
10%
76
+7.6
Composite Score62.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 21.5 + 6.8 + 15.4 + 4.5 + 6.6 + 7.6 = 62.4
Intelligence

Qualitative intelligence

Members
1.7M
Drug spend
$1.0B
Formulary
4-tier
PA / RA level
Low
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
76 days
Strategic notes

Prior collaboration on REMS program; account trust level high

Peer set

Closest peers in Medicare Advantage

United AARP MedicareComplete Managed Care
IL · Tier 2
62.4
-0.0
United AARP MedicareComplete
KS · Tier 2
62.7
+0.3
InnovAge PACE
AK · Tier 2
63.0
+0.6
Blue Shield Medicare Advantage
AL · Tier 2
63.3
+0.9
Commonwealth Care Alliance
AZ · Tier 2
63.9
+1.5
Playbook · Tier 2

Engagement timeline

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