Traditional approach vs. direct approach
In a traditional network, the carrier decides which providers to include, negotiates their rates, and manages the relationship — the employer has essentially no visibility or control. Under direct contracting, the purchaser selects providers from a pool of published rates and terms, and can adjust that selection as needs change, without renegotiating a master contract with a carrier.
Core ongoing tasks
Selection. Choosing which providers to include, and reviewing that choice periodically.
Contracting. Confirming rates and terms are current and still competitive.
Monitoring. Tracking utilization, spend, and network adequacy over time.
Adjustment. Adding or removing providers as the population's needs or a provider's terms change.
Who's responsible
Under a direct-contract model, the purchaser (often supported by a broker or TPA) owns network composition decisions, while the platform handles claims processing, repricing, and providing the visibility needed to make those decisions well.
Metrics that matter
Cost per employee per month, network adequacy relative to where the population lives, utilization by specialty, and how quickly claims move from submission to payment are the numbers that tend to actually drive network changes — not just aggregate "savings" figures.