---
name: manage-the-payer-mix
description: "Read the effective fee by plan and manage PPO write-offs as a deliberate strategy, not an accident. Reach for this when adjustments erode margin."
---

# Skill: Manage the PPO payer mix

PPO write-offs are a strategy decision; this surfaces and manages them.

## Step 1 — Compute the effective fee
Net fee after contractual write-off by plan (§3 #6).

## Step 2 — Map the payer mix
Volume and effective fee by payer.

## Step 3 — Model a mix change
Project margin from dropping/renegotiating a low-effective-fee plan.

## Step 4 — Decide deliberately
Recommend the mix with the volume sensitivity named.

## Output
An effective-fee-by-plan map, a payer-mix model, and a deliberate mix decision.