Direct Contracting Platform RFP Checklist

The direct contracting platform market is getting louder.

Marketplaces, COE networks, navigation layers, contract infrastructure.

On paper, many of these vendors look similar. In practice, there are sharp differences in how much real work they can take off your plate—and how opinionated they are about the model.

If you send a generic RFP, you will get generic answers.

A better approach is to probe a few specific areas where the differences show up quickly.

1. What problem are you built to solve first?

Ask vendors to rank their focus:

• Employer economics
• Member experience
• Provider economics
• Operational simplicity

There is no wrong answer, but you should know which axis they optimize on.

Then ask for two live examples where they traded one dimension off against another.

2. How do you actually get contracts in place?

“Network of direct contracts” can mean many things.

Ask:

• Are your contracts employer-specific, or do employers plug into pre-negotiated templates?
• Who actually signs the agreement—employer or platform?
• How much room is there to customize scope, rates, and steerage for our population?

You want to know whether you are buying a set menu or an à la carte kitchen.

3. What does your claims and TPA integration really look like?

This is where platforms often struggle.

Ask for specifics:

• Which TPAs and ASOs do you already have live integrations with?
• For each, what exactly is integrated (eligibility, pricing, accumulators, reporting)?
• How many new TPAs have you onboarded in the last 12 months, and how long did it take?

Then call one or two reference clients with a similar admin stack and ask them what actually happened.

4. How do you handle steerage?

Most platforms have a story about navigation, but the execution varies.

Probe:

• Who handles outreach to members—your team, theirs, or both?
• Do they run a dedicated nurse/guide team or rely on generic call centers?
• How do they coordinate with your existing navigation vendors or point solutions?

You are trying to understand whether they can be the operating hub for steerage or if they are just one more number for members to ignore.

5. What data do we actually get back?

Data promises are cheap.

Ask for a sample monthly report (anonymized) and look for:

• Steerage metrics
• Unit cost vs. baseline
• Member experience scores
• Operational issues and root causes

If the report reads like a marketing brochure, treat that as a signal.

6. How do you make money?

Pricing models matter for alignment.

Common patterns:

• PEPM fees
• Case rates or per-episode fees
• Shared savings
• Platform fees to providers

Ask how each fee type flows in a typical deal.

You want to understand:

• Where they are neutral
• Where they might be incentivized to grow volume without enough scrutiny

7. What happens when something breaks?

Every program will have surprises.

Ask vendors to walk you through a specific failure mode:

• A member had a bad experience.
• A claims configuration error caused incorrect bills.
• A provider did not meet access or quality expectations.

Who owned the fix? How long did it take? What changed in their process afterward?

You are buying not just a platform, but a way of handling the inevitable problems.

8. Where will you say no to us?

The best platforms have an opinion.

Ask:

“What’s something we might ask for that you’d recommend against—and why?”

Their answer will tell you a lot about how they think and how candid they are willing to be.

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You do not need a 60-page RFP to evaluate direct contracting platforms.

You need a short set of pointed questions that expose how the model really works when it leaves the pitch deck.