For Tufts the second threshold of evaluation for a physician is based on cost efficiency. The cost-efficiency score provided by Mercer is based on standardized costs, so that it measures variations in the use of services between physicians, but not the actual cost of treating an episode of care for a Navigator member. The score is then adjusted for the NWPHO Tufts PPO rates to reflect the actual costs of care for the services.

The final step in computing a Tufts total score for the tiering is to calculate a 50/50 weighting for the quality and cost efficiency scores. Under the GIC plan design, the estimated physician distribution for each specialty is to be approximately 20% in Tier 1, 65% in Tier 2 and 15% in Tier 3. Tufts Health Plan adopted a three-tier approach resulting in three levels of outpatient visit co-payments for specialists.  The level of co-payment were level 1 (excellent, co-pay $15), level 2 (good, co-pay $25) and level 3 (standard, co-pay $35). The following specialists were tiered at an individual level: cardiology, dermatology, endocrinology, gastroenterology, neurology, ophthalmology, orthopedics, otolaryngology, rheumatology, surgery and urology, while obstetricians/gynecologists were tiered at the group level. All primary care physicians are in tier 1 with a $15 co-payment.