PayerIQ
Production
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Tier 3NYRegional

Priority Health of New York

Monitor & nurture — quarterly touchpoints + data sharing

Composite
46.3
Rank
#228
Members
2.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
38
+9.5
Lives
20%
35
+7.0
Geography
20%
58
+11.6
Restrictions
15%
42
+6.3
Relationship
10%
31
+3.1
Financials
10%
88
+8.8
Composite Score46.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 9.5 + 7.0 + 11.6 + 6.3 + 3.1 + 8.8 = 46.3
Intelligence

Qualitative intelligence

Members
2.2M
Drug spend
$0.5B
Formulary
4-tier
PA / RA level
Low
Biosimilar policy
Mandatory substitution
Avg reimbursement
49 days
Strategic notes

Formulary restructure Q3 creates new placement window; timing is critical

Peer set

Closest peers in Regional

Group Health of Delaware
DE · Tier 3
46.5
+0.2
Denver Health Medical Plan of Montana
MT · Tier 3
46.0
-0.3
GuildNet of Virginia
VA · Tier 4
45.9
-0.4
Oscar Health of Oklahoma
OK · Tier 3
47.4
+1.1
Tufts Health Plan of Texas
TX · Tier 4
45.1
-1.1
Playbook · Tier 3

Engagement timeline

Week 2
Account manager check-in
Bi-annually
Formulary monitoring report