DirectCARE Health Alliance

What DirectCARE Health Alliance does

DirectCARE Health Alliance (also doing business as DirectPay Health Plans) is a US-based, privately held healthcare services company founded in 2019 that builds and distributes self-funded and level-funded health plans for employers with 100 or more employees. Its core thesis is direct provider contracting using Reference Based Pricing — reimbursing providers at 120% to 200% of Medicare Allowable — to bypass traditional BUCA (Blue Cross, United, Cigna, Aetna) carrier networks and deliver employer savings of 10-40% versus conventional plans, citing RAND 3.0 hospital price transparency data showing employers and private insurers pay 247% of Medicare rates.

The company sells a three-tier plan portfolio — Core+ (5-15% savings via Tier One BUCA network access), Alliance+ (15-25% savings via regional provider focus), and FMV+ (25-40% savings via direct contracts with no network requirement) — with optional custom-branded plans for hospital/association clients and high-volume employers. All tiers include EngageWELL member advocacy and medical management, 24/7 Virtual Direct Primary Care, Urgent Care, Mental Health services, Care Concierge support, on-demand contracting, transparent PBM and direct-contract pharmacy procurement, and integration with employer-preferred stop-loss carriers.

Go-to-market is direct sales-led via phone (1-800-853-2614), email, and website quote requests, complemented by broker and benefits-advisor partnerships that submit census, claims, and renewal data. The team is extremely small (1-10 employees), revenue and funding are undisclosed, no employer customers are named, and there is no evidence of institutional backing, M&A activity, or a management team identifiable from public sources — limiting the ability to validate commercial traction behind the marketing claims.

Name

DirectCARE Health Alliance

Legal name

DirectCARE Health Alliance

Website

https://www.godirectcare.com

Company type

Private

Founded year

2019

Operating status

Operating

Headcount range

1–10 employees

Ownership category

akta.pro rank

Product category

Employer-Sponsored Health Plan Administration

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Ambulatory Health Care Services (621)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Primary Care & General Medicine Virtual Care (Employer-Sponsored) (HLALADAA)

akta.pro secondary industries

Direct Primary Care (DPC) & Concierge Medicine (HLAFAGAD), Occupational & Employer-Sponsored Primary Care Clinics (HLAFAGAJ)

Keywords

• Self-funded health plans
• Direct provider contracting
• Reference based pricing
• Employer healthcare benefits
• Virtual primary care

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D

Revenue model

1. Health Plan Administration: Administrative fees from managing self-funded and level-funded health plans for employer groups. Revenue derived from plan administration, care coordination services, and provider network access fees.
2. Direct Provider Contract Access: Fees for access to direct provider contracts and Fair Market Value pricing arrangements. Employers pay for reduced balance billing exposure and transparent pricing.

Pricing tiers

Go-to-market motion1 record

Distribution channels2 records

Marketing channels4 records

Core offering

DirectCARE Health Alliance administers employer-sponsored health plans (Core+, Alliance+, FMV+) that enable employers to purchase healthcare services directly from providers using Reference Based Pricing at 120% to 200% of Medicare Allowable rates. Plans include member advocacy through EngageWELL, virtual primary care, urgent care, mental health services, and care concierge support for groups with 100+ employees.

Product overview

DirectCARE Health Alliance offers a platform of health plans and healthcare services built around direct provider relationships. The core portfolio consists of three health plan tiers: Core+ (5-15% savings with national network access), Alliance+ (15-25% savings with regional provider focus), and FMV+ (25-40% savings with fair market value pricing and no network requirements). These plans are complemented by Virtual Direct Primary Care (24/7 physician access), Urgent Care, Mental Health Services, and Care Concierge/Advocacy support. The company facilitates direct contracts between employers and healthcare providers, eliminating traditional insurance middlemen. All plans include options for Level Funded or Traditional Self-Funded arrangements, member advocacy through EngageWELL, medical management, and pharmacy benefit management through direct acquisition.

Differentiator

Problem solved

Functional benefit

Products and services

• Core+ Health Plan

Quantifiable outcome

• 10-40% reduction in employer healthcare costs compared to traditional insurance middlemen
• +5 more outcomes

Segments3 records

Ideal customer profiles1 record

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Two partnerships are on record, tiered supporting.

• Stop-Loss Carriers (Unnamed)supportingOthersPartnership with stop-loss insurance carriers to manage catastrophic claims exposure for self-funded employer plans. DirectCARE has ability to work with employer's preferred stop-loss carrier for seamless plan administration.
• Tier One National Network (BUCA)supportingTechnology or IntegrationAccess to BUCA (Blue Cross, United, Cigna, Aetna) provider networks available through Core+ plan tier as an option for employers preferring traditional network access alongside direct contracting benefits.

Scale indicators3 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• Centivo: Centivo partners with employers to offer health plans built around a primary-care-centric, direct-contracting model. Most directly comparable to DirectCARE in serving self-funded employers with DPC + reference-based-style pricing.
• Imagine360 (formerly HSM/Imagine Health): Imagine360 administers self-funded employer health plans using reference-based pricing and direct provider contracting. Closely comparable business model, target buyer (mid-large employers), and RBP mechanics.
• Collective Health: Collective Health is a technology-led third-party administrator for self-funded employer plans. Comparable as a modern TPA target for mid-large employers seeking an alternative to incumbent carriers.
• Premise Health: Premise Health operates employer-sponsored primary care clinics (including on-site and near-site) and integrated wellness. Comparable via employer-sponsored primary care delivery and member-experience focus.
• Marathon Health: Marathon Health delivers employer-sponsored primary care (on-site, near-site, virtual) plus population health. Comparable through employer DPC delivery and integrated care model.
• Accresa: Accresa is a platform that enables employers to offer direct primary care and ancillary benefits via individual contribution accounts. Comparable in combining DPC and employer benefit administration in a direct-contracting frame.
• Take Command Health: Take Command Health supports employers and individuals with self-funded/level-funded plan administration and HRA/benefit design. Comparable alternative-administration approach for self-funded buyers.

Broad incumbents

• Surest (UnitedHealth Group): Surest is a UnitedHealth-owned, price-transparent employer health plan product that competes for the same employer buyer. Comparable as an incumbent-disruption alternative plan, though operated within a much larger carrier.

Emerging players

• Sana Benefits: Sana provides small-to-mid employer health plans with a focus on cost transparency and direct-style contracting. Comparable emerging player targeting self-funded employers with modern plan design.
• Lyra Health: Lyra provides employer-sponsored mental health benefits integrated into health plans. Comparable component-level to DirectCARE's bundled mental health offering within its employer plan tiers.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/directcare

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about DirectCARE Health Alliance