PayerIQ
Production
Back to universe
Tier 3TNRegional

Tufts Health Plan of Tennessee

Monitor & nurture — quarterly touchpoints + data sharing

Composite
56.8
Rank
#170
Members
2.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
66
+16.5
Lives
20%
40
+8.0
Geography
20%
78
+15.6
Restrictions
15%
57
+8.5
Relationship
10%
28
+2.8
Financials
10%
53
+5.3
Composite Score56.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.5 + 8.0 + 15.6 + 8.5 + 2.8 + 5.3 = 56.8
Intelligence

Qualitative intelligence

Members
2.5M
Drug spend
$0.9B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
Mandatory substitution
Avg reimbursement
86 days
Strategic notes

Prior collaboration on REMS program; account trust level high

Peer set

Closest peers in Regional

Community Health Options of North Dakota
ND · Tier 3
56.3
-0.5
Sharp Health Plan of Arkansas
AR · Tier 3
57.4
+0.6
CareFirst of Ohio
OH · Tier 3
57.8
+1.0
Rocky Mountain Health Plans of North Dakota
ND · Tier 3
55.6
-1.1
Johns Hopkins Health Plans of Missouri
MO · Tier 2
58.2
+1.5
Playbook · Tier 3

Engagement timeline

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