How to Find the Right Employers for a Direct Contract

If you’re exploring direct-to-employer contracting for your practice, one of the first questions you’ll run into is: who should we be reaching out to?

Not every employer is a good fit—and that’s actually a good thing. The goal isn’t to land as many contracts as possible. It’s to find the right ones: groups who are local, self-funded, and positioned to benefit from the kind of care you already deliver.

Let’s walk through what makes an employer a strong candidate for a direct contract—and how to prioritize your outreach.

What Is a Self-Funded Employer?

In a self-funded health plan, the employer—not the insurance company—is the one paying claims. They take on the financial risk and typically work with a third-party administrator (TPA) and/or benefits broker to help manage the plan.

This setup gives the employer more control. They’re not locked into rigid networks or pricing, which gives them a unique opportunity to build plans that work best for their employees. 

It’s also more common than you might think. As of 2023, nearly 63% of U.S. workers are covered by a self-funded plan according to KFF’s 2024 Employer Health Benefits Survey. That includes large national employers, but also plenty of mid-sized businesses and public sector groups in your own backyard.

A Smart Place to Start: Public Sector Employers

If you’re trying to stay local, the public sector often checks all the right boxes.

Cities, counties, school districts, first responders, and other government agencies are frequently self-funded. They typically have enough employees to make a program worthwhile and tend to be more community-oriented in their partnerships. They also care about things like reducing injuries, keeping people at work, and making sure benefits actually work for their team.

Best of all? You probably already know someone who works for one of them—a warm intro might be all you need to open the door.

Size Matters (But Don’t Overthink It)

As a general rule, look for employers with at least 250 employees. That gives you a large enough group to demonstrate impact—through better outcomes, lower MSK costs, or fewer lost workdays.

Some groups with 100–250 employees may still be a good fit, especially if:

• They’re easy to reach or already in your network
• They have a demonstrated desire to reduce rising MSK costs

Very small companies tend to be fully insured and more limited in what they can do (either because of plan design or bandwidth)—so focus your energy where it’s likely to pay off.

Understand Who You’re Really Selling To

Before reaching out, it helps to know how the employer makes benefit decisions. Some are hands-on, managing everything internally. Others partner with brokers or consultants who advise on—and sometimes gatekeep—new solutions.

Both paths can work. You just need to approach each one differently. If you’re not sure where to start, this podcast episode with Dave Kerrigan breaks down what brokers care about and how to position your offer to make sense for them, too.

Build a Smarter Prospecting Checklist

You don’t need a sales team. You just need a little structure.

Here’s a simple framework to qualify employer leads:

• Are they self-funded?
  If you’re not sure, ask someone in HR or look for job listings that mention a TPA or claims partner.
  
  
• Do they have at least 250 employees?
  Bigger isn’t always better—but too small can stall momentum.
  
  
• Are they based in your local market?
  Proximity matters. It makes delivery easier and the relationship stronger.
  
  
• Do you or someone on your team know someone there?
  Warm intros are gold. Ask your staff, your patients, and your professional network.
  
  
• Are they working with a broker or consultant?
  Understanding their buying process helps you approach with the right message.
  
  
• Do they already have MSK or PT solutions in place?
  If so, is there an opportunity to replace or complement what’s there?
  
  

For a deeper walkthrough of how to research and qualify employer targets, check out our Employer Discovery Guide.

Final Thought: Start Small, Start Smart

You don’t need five contracts out of the gate. You need one employer who’s open to trying something better. Building a strong partnership from the start will help both of you create the best possible outcome.

By focusing on the right targets—local, self-funded, and the right size—you give yourself the best shot at a successful partnership. And once you have the playbook built, it’s a lot easier to repeat the process.

Ready to Take the Next Step? We're Here to Help.

Second Door’s Employer Direct tools are built for PT practices looking to grow through local contracts. From prospecting and outreach to proposals and performance tracking, we give you everything you need to run a professional employer sales process—without hiring a sales team. Let's talk about how we can help you land that first contract—request a demo today.