PayerIQ
Production
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Tier 4WIRegional

CareFirst of Wisconsin

Deprioritize — minimal contact + revisit annually

Composite
40.4
Rank
#247
Members
0.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
43
+10.8
Lives
20%
10
+2.0
Geography
20%
51
+10.2
Restrictions
15%
26
+3.9
Relationship
10%
75
+7.5
Financials
10%
60
+6.0
Composite Score40.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 10.8 + 2.0 + 10.2 + 3.9 + 7.5 + 6.0 = 40.4
Intelligence

Qualitative intelligence

Members
0.6M
Drug spend
$0.1B
Formulary
6-tier
PA / RA level
Moderate
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
58 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in Regional

Capital Health Plan of South Carolina
SC · Tier 4
41.6
+1.3
Oscar Health of Kentucky
KY · Tier 4
42.4
+2.0
UCare of Colorado
CO · Tier 4
42.4
+2.0
Physicians Health Plan of Maryland
MD · Tier 4
43.1
+2.8
Tufts Health Plan of Texas
TX · Tier 4
45.1
+4.8
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier