PayerIQ
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Tier 1SCRegional

Sunshine Health of South Carolina

Priority engagement — executive meetings + contract acceleration

Composite
76.7
Rank
#11
Members
5.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
84
+21.0
Lives
20%
100
+20.0
Geography
20%
100
+20.0
Restrictions
15%
13
+1.9
Relationship
10%
72
+7.2
Financials
10%
65
+6.5
Composite Score76.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 21.0 + 20.0 + 20.0 + 1.9 + 7.2 + 6.5 = 76.7
Intelligence

Qualitative intelligence

Members
5.3M
Drug spend
$1.3B
Formulary
5-tier
PA / RA level
Low
Biosimilar policy
No policy defined
Avg reimbursement
81 days
Strategic notes

Recent merger with regional system creates expanded formulary committee access

Peer set

Closest peers in Regional

CareFirst of Massachusetts
MA · Tier 1
77.1
+0.4
Denver Health Medical Plan of Minnesota
MN · Tier 1
79.1
+2.4
Providence Health of Connecticut
CT · Tier 1
72.7
-4.0
ConnectiCare of North Carolina
NC · Tier 2
70.9
-5.8
Dean Health Plan of Mississippi
MS · Tier 2
69.8
-6.8
Playbook · Tier 1

Engagement timeline

Week 1
Executive sponsor outreach · contract review
Week 2
Account team alignment · data sharing MoU
Week 4
Strategic roadmap session
Quarterly
C-suite QBR · joint planning