What I've Learned from 14 Years of Direct Contracting

What 14 Years of Direct Contracting Has Taught Josh Bailey

Before “direct care” was a buzzword, Dr. Josh Bailey was living it.

In this episode of The Direct Path, Josh—CEO of Rehab Associates of Central Virginia—pulls back the curtain on what it’s actually like to build direct-to-employer contracts from the ground up. With over 14 years of experience (and counting), he offers a brutally honest, highly practical take on how practices can stop waiting for insurance to pay more—and start getting paid differently instead.

Josh shares how he went from cold-calling employers with no clear pitch to becoming one of the most respected voices in the movement for physical therapists to reclaim their role as MSK primary care providers. He’s now helping lead APTA’s Direct-to-Employer Services designation and continues to advocate for models that remove administrative waste, restore referral power to PTs, and build true alignment with those who pay for care.

You’ll hear why his team stopped selling physical therapy and started solving employer problems, how they turned awkward first conversations into long-term partnerships, and what happens when PTs shift from being receivers of referrals to drivers of outcomes. He also dives into:

• The real business math behind shrinking margins
• How direct access laws changed everything
• What industries are a good fit for direct contracts—and which aren’t
• Where digital MSK solutions fit, and where they fall short
• How being part of a patient’s first step can change everything
  

“If it’s not a win for the patient, the employer, and the provider—it’s going to blow up.” — Dr. Josh Bailey

This episode isn’t just about vision—it’s about execution. Whether you’re running a single-site practice or overseeing a regional network, Josh’s playbook is a must-listen for any PT leader ready to take ownership of their revenue, their care pathways, and their future.