High-Value Specialty Contracting Targets
| Specialty | Average Annual Spend | Direct Contract Savings Potential |
|---|---|---|
| Cardiology | $500K–$2M | 20–35% |
| Oncology | $500K–$3M | 15–30% |
| Orthopedics/MSK | $300K–$1.5M | 25–40% |
| Spine surgery | $200K–$1M | 30–50% |
| Maternity | $200K–$800K | 15–25% |
Member Steerage
Direct specialty contracts require member steerage — incentives for members to use the contracted provider. Common steerage mechanisms: $0 cost-sharing at the contracted provider vs. standard cost-sharing elsewhere; care navigation support to help members access the contracted provider; and communication campaigns that promote the contracted provider's quality and convenience.
Outcomes Guarantees
IQ Insight
Advanced direct specialty contracts include outcomes guarantees — the provider guarantees specific clinical outcomes (e.g., 30-day readmission rate below 5% for cardiac surgery) and accepts financial penalties if outcomes fall short. Outcomes guarantees align provider incentives with quality and provide the employer with protection against poor outcomes. They are a hallmark of sophisticated direct contracting arrangements.