PayerIQ
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Tier 2TNRegional

GuildNet of Tennessee

Active pursuit — access summits + value dossier

Composite
63.0
Rank
#91
Members
4.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
55
+13.8
Lives
20%
87
+17.4
Geography
20%
63
+12.6
Restrictions
15%
69
+10.3
Relationship
10%
35
+3.5
Financials
10%
54
+5.4
Composite Score63.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 13.8 + 17.4 + 12.6 + 10.3 + 3.5 + 5.4 = 63.0
Intelligence

Qualitative intelligence

Members
4.4M
Drug spend
$1.3B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
74 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in Regional

WellStar Health of Arizona
AZ · Tier 2
62.6
-0.4
UCare of Nebraska
NE · Tier 2
62.5
-0.5
Blue Care Network of Pennsylvania
PA · Tier 2
62.2
-0.8
Medica Health Plans of Tennessee
TN · Tier 2
61.8
-1.3
HealthNew England of Nevada
NV · Tier 2
64.5
+1.5
Playbook · Tier 2

Engagement timeline

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