PayerIQ
Production
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Tier 2VAFederal

Centers for Medicare & Medicaid Services (CMS) HMO

Active pursuit — access summits + value dossier

Composite
61.6
Rank
#109
Members
29.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
65
+16.3
Lives
20%
88
+17.6
Geography
20%
40
+8.0
Restrictions
15%
10
+1.5
Relationship
10%
99
+9.9
Financials
10%
84
+8.4
Composite Score61.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.3 + 17.6 + 8.0 + 1.5 + 9.9 + 8.4 = 61.6
Intelligence

Qualitative intelligence

Members
29.5M
Drug spend
$6.3B
Formulary
5-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
60 days
Strategic notes

Executive sponsor identified at VP of Pharmacy level; schedule quarterly touchpoint

Peer set

Closest peers in Federal

Medicare Advantage National HMO
DC · Tier 2
62.0
+0.3
Medicare Part D National Program
MD · Tier 2
59.8
-1.9
Centers for Medicare & Medicaid Services (CMS) Health Plan
DC · Tier 2
59.8
-1.9
Centers for Medicare & Medicaid Services (CMS)
VA · Tier 2
58.8
-2.9
TRICARE (Defense Health Agency)
DC · Tier 2
58.3
-3.4
Playbook · Tier 2

Engagement timeline

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