Direct Contracting Program Management

A single point of accountability for your direct-to-employer contracts.

PassThruHealth structures, manages, and defends your direct-contract terms with employer-sponsored health plans — so your rates hold, your claims route correctly, and your team isn't managing five broker relationships to get one referral pattern right.

Request a Meeting See How It Works
TPA infrastructure operated through a dedicated third party administrator (TPA)
How the relationship is structured
Health System Sets rates & terms Employer Plan / Broker Accesses network PassThruHealth Program Manager TPA Partner Routes & settles claims
14
States with live provider agreements
1
TPA partner handling all claims routing
90–120
Days to implement a new employer group
How It Works

One agreement. One point of contact. No per-employer renegotiation.

You negotiate contract terms once, with us. We handle everything downstream — onboarding new employer groups, coordinating the TPA, and keeping claims routing accurate — without reopening your agreement each time.

01
You set the terms
Your health system defines Provider Rates, covered services, and program requirements directly with PassThruHealth — a single negotiation, not one per employer.
02
We structure and manage the agreement
PassThruHealth acts as program manager: drafting the direct-contract terms, onboarding the employer, and coordinating with all employee benefit brokers and consultants on your behalf. Independence maximizes the distribution of your direct model in the communities you serve.
03
Employer plans gain access
Employer-sponsored plans and their Participants access your network under the terms you set — without you managing each employer relationship individually.
04
Simplicity for employees
Employees have access to your direct contracts and a national BUCA wrap network, enabling easy eligibility confirmation at the provider's front desk and seamless claims processing for members — no friction, just the care they need.
05
Claims route through one TPA
Our third party administrator (TPA) handles claims routing and settlement consistently across every employer group in the program — one process to audit, not dozens.
Why Health Systems Partner With Us

Built around what your leadership team actually evaluates.

For the CFO
Predictable revenue & no bad debt
Direct-contract terms you set once, with rate integrity protected by exclusivity and audit provisions — not renegotiated away by intermediaries you don't control. Members access care for just a copay, with the employer covering the rest — eliminating bad debt collection.
For the CMO / VP Strategy
A defined, governed relationship
Termination-for-cause rights, insurance minimums, and clear program governance mean the relationship is structured like a partnership — not an open-ended vendor arrangement.
For Legal & Compliance
HIPAA-conscious by design
Confidentiality terms are built to permit de-identified, operational data sharing for program management — while preserving HIPAA protections throughout.
Compliance & Governance

Every agreement is designed for review by qualified healthcare counsel before execution. Everything starts from an industry norm position focusing on value alignment, not value extraction.

Counsel-reviewed contract terms
Every agreement structure is designed for review by qualified healthcare counsel before execution. Nothing here is a substitute for that review.
Established TPA infrastructure
Claims routing runs through an established third party administrator (TPA) — ensuring consistency of service delivery across all plans.
Defined audit & termination rights
Program agreements include termination-for-cause and audit provisions, giving your health system real recourse — not just a service-level promise.
Get Started

Considering direct contracting? Let's map your revenue opportunity first.

A first meeting takes 30 minutes and covers how a direct-contract program would work for your specific geographic region, employer base, rate structure, and clinical capabilities.

Request a Meeting Download Program Overview
Get In Touch

Request a meeting.

Tell us a bit about your health system and we'll follow up to schedule a 30-minute introductory call.

Prefer to book a time directly? Contact us to get scheduled →