PayerIQ
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Tier 2TNRegional

Medica Health Plans of Tennessee

Active pursuit — access summits + value dossier

Composite
61.8
Rank
#108
Members
4.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
74
+18.5
Lives
20%
86
+17.2
Geography
20%
63
+12.6
Restrictions
15%
17
+2.5
Relationship
10%
49
+4.9
Financials
10%
60
+6.0
Composite Score61.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 18.5 + 17.2 + 12.6 + 2.5 + 4.9 + 6.0 = 61.8
Intelligence

Qualitative intelligence

Members
4.2M
Drug spend
$1.5B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Mandatory substitution
Avg reimbursement
73 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in Regional

PreferredOne of Wyoming
WY · Tier 2
61.4
-0.4
Blue Care Network of Pennsylvania
PA · Tier 2
62.2
+0.5
Johns Hopkins Health Plans of Oregon
OR · Tier 2
61.1
-0.6
UCare of Nebraska
NE · Tier 2
62.5
+0.8
WellStar Health of Arizona
AZ · Tier 2
62.6
+0.9
Playbook · Tier 2

Engagement timeline

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