How It Works
A direct-care model that replaces transactional complexity with one relationship and one predictable monthly rate.
The Direct Specialty Care Model
Longitude operates as a purpose-built network of specialists, surgeons, and outpatient facilities — a population-driven model based on pre-paid memberships. We contract directly via a per-member-per-month (PMPM) arrangement with a select network of specialty physicians, surgeons, and outpatient facilities. Like Direct Primary Care (DPC), Longitude compensates network providers based on a PMPM payment calculated by the number of member enrollments.
Partnership
Your health plan partners with Longitude. The plan pays a predictable monthly rate per enrolled member, set at the start of each enrollment period and adjusted for the age profile of the enrolled population.
Provider Payment
Longitude pays network providers their PMPM rate monthly — eliminating billing, collections, and denial overhead for covered services.
Member Access
Enrolled members receive a dedicated Patient Advocate and direct access to network specialists — no pre-authorization required.
Covered Services
Visit a Longitude network provider. Covered services are delivered without out-of-pocket cost — no claims, no EOB statements, no bills to reconcile after the visit.
For Payers
Longitude gives payers a predictable, stable annual expenditure for specialty and surgical care. Here is how:
- Payers pay a PMPM rate that does not fluctuate based on utilization. The cost is the same regardless of how often members use covered services.
- The PMPM rate is transparent and based on a defined menu of covered services, adjusted for the age profile of the enrolled population at each renewal.
- Because payment does not require claims processing, authorizations, or point-of-care cost-sharing, administrative costs are significantly reduced — especially when paired with a Direct Primary Care arrangement.
- A single-source vendor relationship reduces costs, increases quality, and improves physician-patient relationships through volume.
For employer plans, Longitude delivers 10–20% savings on the same specialty services and predictable specialty-care spend from one enrollment period to the next.
For Medicaid MCOs, Longitude provides a cost-stable way to expand specialty and surgical access without adding administrative friction to MCO operations and without introducing transactional barriers for members.
For Tribal health plans, Longitude extends specialty and surgical access under a governance structure set by the Tribal Nation, working alongside IHS benefits and Purchased/Referred Care rather than replacing them.
For Members
- No out-of-pocket cost for covered services
- No EOB statements or confusing bills
- High-quality providers chosen for excellent outcomes
- Familiar physicians and facilities
- Streamlined access — no waiting for referral authorization
- Curated network focused on high-outcome specialists and facilities
When a Service Is Not Covered
Services not covered by Longitude's network are addressed by those provided under the health plan.
| Medical Event | Services | Coverage & Cost | What to Know |
|---|---|---|---|
| Office Visit | Primary Care | Covered under your existing health plan | See your plan for details |
| Specialist Visit | Longitude Network Specialists | Covered — no out-of-pocket cost | Other specialists billed under insurance |
| Lab & Imaging | Outpatient CT, Outpatient MRI, Outpatient Lab Tests | Covered — no out-of-pocket cost | PET Scans excluded |
| Medications | Prescriptions | Not Covered | Billed through insurance |
| Ambulatory Surgery | Longitude Network Procedures | Covered — no out-of-pocket cost | Other procedures billed under insurance |
| Emergency / Urgent Care | ER or Urgent Care | Not Covered | Billed under health plan |
| Hospitalization | Inpatient | Not Covered | Billed under health plan |
What Is Capitation — And Why We Use It Differently
Capitation is a payment model in which a healthcare provider receives a fixed, per-member-per-month (PMPM) fee in exchange for delivering a defined set of services — regardless of how many times a patient is seen or what services are used.
Historically, capitation was deployed as a risk-shifting tool. Insurance companies and managed care organizations used it to transfer financial risk from the payer to the provider. If a patient used more services than the capitated rate covered, the provider absorbed the loss. This created misaligned incentives and gave capitation a complicated reputation in healthcare.
For us, capitation is not about risk. It is about eliminating friction.
The traditional fee-for-service model generates an enormous administrative burden — claims submission, coding, denials management, revenue cycle operations, clearinghouse fees, and endless back-and-forth between providers and payers. These activities consume time, staff, and resources that belong at the point of care, not in the billing department.
By using capitation as a payment mechanism rather than a risk tool, we replace that entire transactional layer with a single, predictable monthly payment. No claims. No billing cycles. No revenue cycle management. No transaction fees. Just a straightforward agreement — a fixed fee for a defined scope of care — that lets providers focus on patients and lets organizations budget with certainty.
The result is a simpler, faster, and more transparent relationship between payers and providers — built on alignment rather than risk transfer.
Questions About How It Works?
Our team is ready to walk you through the model and answer any questions.