PayerIQ
Production
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Tier 2KSRegional

MetroPlus Health Plan of Kansas

Active pursuit — access summits + value dossier

Composite
66.5
Rank
#64
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
76
+19.0
Lives
20%
47
+9.4
Geography
20%
58
+11.6
Restrictions
15%
76
+11.4
Relationship
10%
65
+6.5
Financials
10%
86
+8.6
Composite Score66.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 19.0 + 9.4 + 11.6 + 11.4 + 6.5 + 8.6 = 66.5
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$0.9B
Formulary
5-tier
PA / RA level
Very High
Biosimilar policy
Step therapy required
Avg reimbursement
85 days
Strategic notes

Data-sharing agreement pending legal review; delay contracting until finalized

Peer set

Closest peers in Regional

WPS Health Solutions of California
CA · Tier 2
66.2
-0.3
HarmonyCare of Virginia
VA · Tier 2
66.2
-0.3
Crystal Run Health Plan of Illinois
IL · Tier 2
66.0
-0.5
SelectCare of Utah
UT · Tier 2
67.0
+0.5
UCare of Alaska
AK · Tier 2
67.6
+1.1
Playbook · Tier 2

Engagement timeline

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