Staffing a Direct Contracting Program With a Small Team

One quiet fear in many benefits teams:

“If we start direct contracting, are we signing up for a whole new department?”

You do not need a massive internal team to run a thoughtful program.

But you cannot assume your existing benefits staff can absorb everything on top of business as usual.

The solution is to be explicit about roles, time, and partners.

The core roles

At minimum, a direct contracting program needs three internal roles:

1. Sponsor (usually the CFO or CHRO).

   • Owns the “why now” and signs off on deals.
   • Communicates with the board and executive team.

2. Program owner (benefits + finance hybrid).

   • Day-to-day accountable owner.
   • Coordinates between employer, provider, TPA, and vendors.
   • Owns the dashboard and quarterly reviews.

3. Data/analytics support.

   • Pulls baseline and ongoing claims views.
   • Helps evaluate opportunities and track results.

On top of that, you will lean on:

• Your TPA or ASO team
• Navigation or COE vendors
• Legal counsel for contract structure

The key is not to do everything in-house, but to have one person who wakes up thinking about the program.

How much time does it really take?

For a single pilot:

• Design and negotiation:

  • 4–8 weeks of intermittent work
  • Heaviest lift for the program owner, with sponsor and legal in specific windows

• Implementation:

  • 6–10 weeks
  • Coordination with TPA, providers, navigation, and communications teams

• Steady-state:

  • A few hours per week for the program owner to monitor metrics and resolve issues
  • Quarterly reviews that pull in the sponsor and partners

If your team is already underwater, you may need to free up capacity elsewhere or bring in temporary project support.

When to lean on external partners

The places where outside help often makes sense:

• Opportunity analysis. Vendors or advisors who can help you mine claims for realistic starting points.
• Contract templating. Legal partners with experience in direct contracts and value-based components.
• Implementation project management. Someone who has lived through the TPA and provider configuration maze before.

What you should not outsource entirely:

• The decision logic about which markets and service lines to pursue.
• The story you tell to your board and employees.

Those pieces are too closely tied to your culture and risk tolerance.

Signs you’re under-staffed

Watch for these warning lights:

• Direct contracting work only happens nights and weekends.
• No one can answer basic status questions without digging through email.
• Issues get bounced between HR, finance, and vendors with no clear owner.

If you see those, you are running on heroics, not a real program.

The fix is usually to give the program owner explicit time and authority, not to hire a dozen new people.

Building a tiny but real program office

Even in a small benefits team, you can create a “program office” feel by:

• Naming the roles and publishing them internally.
• Creating a simple cadence:
  • Weekly 30-minute check-in with core team during implementation.
  • Monthly check-in in steady-state.
  • Quarterly review with sponsor and provider.
• Keeping a single source of truth (one shared tracker for deals, metrics, and issues).

Direct contracting doesn’t have to take over your org chart.

But it does need someone to own the work.

Clarity beats headcount.