Compare the MCO's profile for member age, sickness, and sex to the physician's patient profile. If the plan's profile, for example, contains a larger number of elderly patients than the physician presently services, the physician can expect a greater incidence of illness among the plan's patient population. This is important to know when negotiating a capitated payment. It is also important when negotiating fee discounts or a new fee schedule, to ensure that payments for illnesses specific to an elderly population are adequate. The lower the patient copayment or deductible, the higher utilization will be.
Many plans offer a menu of options, with varying deductibles and copayments.
Find out the members' preference among those options.