Why rate-setting traditionally sat with carriers
In a carrier-run network, a provider's access to a large pool of employer-sponsored patients is bundled with accepting the carrier's rates. Individual providers, especially smaller practices, typically have limited ability to negotiate those rates upward — the carrier's network is large, and any one provider's leverage within it is small.
What changes with direct contracting
A provider on a direct-contract platform sets rates independently for each purchaser relationship (or publishes a general rate sheet purchasers can select into). The provider isn't negotiating against a single large counterparty for access to an entire market — they're setting terms and letting individual purchasers decide whether those terms work for them.
What providers typically weigh
Cost to deliver the service, current patient volume and capacity, competitive rates in their local market, and how much administrative complexity a given purchaser relationship adds all factor into how a provider prices their services under direct contracting.
How this connects to network selection
A provider's published rate and terms are what purchasers see when deciding whether to include that provider in their network. Rate-setting and network selection are two sides of the same mechanism: providers set terms, purchasers choose based on those terms, and the two decisions together are what "direct contracting" actually means in practice.