PayerIQ
Production
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Tier 3WACommercial

Tufts Health Plan

Monitor & nurture — quarterly touchpoints + data sharing

Composite
50.8
Rank
#202
Members
2.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
47
+11.8
Lives
20%
66
+13.2
Geography
20%
59
+11.8
Restrictions
15%
17
+2.5
Relationship
10%
63
+6.3
Financials
10%
52
+5.2
Composite Score50.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 11.8 + 13.2 + 11.8 + 2.5 + 6.3 + 5.2 = 50.8
Intelligence

Qualitative intelligence

Members
2.4M
Drug spend
$0.6B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Mandatory substitution
Avg reimbursement
27 days
Strategic notes

Recent merger with regional system creates expanded formulary committee access

Peer set

Closest peers in Commercial

UPMC Health Plan
AK · Tier 3
49.6
-1.1
PreferredOne PPO
CA · Tier 3
52.0
+1.2
Crystal Run Health Plan
ID · Tier 3
52.9
+2.1
WellStar Health
WI · Tier 3
48.6
-2.2
Excellus BlueCross BlueShield HMO
TX · Tier 3
47.4
-3.4
Playbook · Tier 3

Engagement timeline

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