PayerIQ
Production
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Tier 2NYRegional

Tufts Health Plan of New York

Active pursuit — access summits + value dossier

Composite
58.8
Rank
#146
Members
2.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
61
+15.3
Lives
20%
55
+11.0
Geography
20%
50
+10.0
Restrictions
15%
50
+7.5
Relationship
10%
71
+7.1
Financials
10%
79
+7.9
Composite Score58.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.3 + 11.0 + 10.0 + 7.5 + 7.1 + 7.9 = 58.8
Intelligence

Qualitative intelligence

Members
2.6M
Drug spend
$0.8B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
46 days
Strategic notes

Prior collaboration on REMS program; account trust level high

Peer set

Closest peers in Regional

Arkansas Blue Cross of Oklahoma
OK · Tier 2
58.5
-0.2
UPMC Health Plan of Nevada
NV · Tier 2
59.1
+0.4
SelectCare of New York
NY · Tier 2
58.3
-0.5
Mountain Health of Idaho
ID · Tier 2
59.3
+0.5
Johns Hopkins Health Plans of Missouri
MO · Tier 2
58.2
-0.5
Playbook · Tier 2

Engagement timeline

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