PayerIQ
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Tier 3CTRegional

Tufts Health Plan of Connecticut

Monitor & nurture — quarterly touchpoints + data sharing

Composite
48.7
Rank
#215
Members
3.8M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
51
+12.8
Lives
20%
70
+14.0
Geography
20%
34
+6.8
Restrictions
15%
23
+3.4
Relationship
10%
82
+8.2
Financials
10%
35
+3.5
Composite Score48.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 12.8 + 14.0 + 6.8 + 3.4 + 8.2 + 3.5 = 48.7
Intelligence

Qualitative intelligence

Members
3.8M
Drug spend
$1.2B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
No policy defined
Avg reimbursement
35 days
Strategic notes

Large dual-eligible population; PA/RA process requires clinical evidence package

Peer set

Closest peers in Regional

New Mexico Health Connections of Kansas
KS · Tier 3
48.8
+0.0
CareFirst of Kentucky
KY · Tier 3
49.0
+0.3
Premera Blue Cross of Louisiana
LA · Tier 3
48.0
-0.7
New Mexico Health Connections of Washington
WA · Tier 3
47.8
-0.9
HarmonyCare of Delaware
DE · Tier 3
47.6
-1.1
Playbook · Tier 3

Engagement timeline

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