Ever wonder why healthcare costs so much—even when you have insurance? Direct contracting is changing that.
For years, healthcare pricing has been a mystery. You go to the doctor, get treatment, and weeks later, a surprise bill arrives—often higher than expected. Why? Traditional insurance-driven pricing is layered with middlemen, administrative fees, and inflated costs. Direct contracting removes the confusion by cutting out unnecessary third parties, giving you clear, predictable pricing, and better access to care.
What Is Direct Contracting in Healthcare?
Direct contracting is a simpler, more transparent way to access healthcare services without relying entirely on traditional insurance middlemen. It allows employers, healthcare providers, and even individuals to negotiate costs directly with doctors, hospitals, and specialists. Instead of letting insurance companies dictate what a medical service costs, direct contracting establishes fair, upfront pricing, making healthcare more predictable and affordable.
A study by the American Medical Association found that direct employer contracting allows companies to negotiate directly with healthcare providers, leading to more predictable costs and improved provider reimbursement rates.
This approach benefits everyone involved:
- Patients get better access to care.
- Providers are paid fairly and promptly.
- Employers can reduce overall healthcare costs by cutting out unnecessary intermediaries and administrative fees.
Why Direct Contracting Is a Game-Changer
1. No More Inflated Costs
Traditional healthcare pricing is confusing and inconsistent. The same procedure can cost vastly different amounts depending on the provider, insurer, location, and even the time of year.
A report from Healthcare Finance News found that three-quarters of Accountable Care Organizations (ACOs) participating in the Direct Contracting Model achieved cost savings, proving that when middlemen are removed, pricing becomes more predictable and aligned with fair-market values.
2. Better Access to Care
When providers don’t have to jump through insurance hoops, they can focus on what matters: treating patients. Direct contracting eliminates network restrictions, allowing patients to see the best doctors without delays or unnecessary referrals.
A study on employer health plans conducted by BenefitsPRO found that 76% of employers aimed to achieve savings between 6% and 20% through direct contracting. The study highlights how businesses are leveraging direct contracts with healthcare providers to lower costs while maintaining high-quality care for employees.
3. More Predictable Pricing
One of the biggest frustrations in healthcare is not knowing how much a service will cost until after you receive the bill. With direct contracting, pricing is clear and upfront, so there are no surprise bills.
In 2022, the Global and Professional Direct Contracting Model saved the Centers for Medicare and Medicaid Services (CMS) $371.5 million, demonstrating the financial efficacy of direct contracting.
4. Improved Doctor-Patient Relationships
With fewer administrative burdens and insurance-related red tape, doctors can spend more time with patients instead of rushing through appointments. This leads to better, more personalized care.
In 2022, the average total quality score across Direct Contracting Entities was 99.4%, reflecting high levels of patient satisfaction and quality care.
How to Get Started with Direct Contracting
For Employees:
Check with your HR team to see if your company already offers services that include direct contracting. Many companies are adopting this model to provide better healthcare options at lower costs.
If your employer hasn’t explored direct contracting yet, consider advocating for it as a cost-saving, high-quality alternative to traditional insurance-based care.
For Employers:
Businesses looking to adopt direct contracting should start by evaluating their current healthcare expenses and speaking with providers who offer direct care agreements.
Advanced Primary Care Plus (APC+) is a direct contracting model that gives employees better access to primary care, making it easier to transition into this model.
TL;DR: Why Direct Contracting Matters
- Fair pricing, no insurance middlemen
- Faster, better access to doctors
- No surprise bills or hidden fees
- Lower costs for employers & employees
- More time with your doctor = better care
Want a healthcare experience without the hassle of surprise bills and unnecessary red tape?
Learn how Apaly is helping employers, employees, and providers directly contact Advanced Primary Care Plus on a national scale.
