The short answer
It comes down to who holds the clinical decisions and who carries the business work. Solo practice gives you full control and all the admin. Group practices and platforms take admin off your plate but often set your schedule or volume. A supported contractor network aims to keep practice-level autonomy while handling the business side.
Which practice model gives a therapist the most control?
Solo private practice gives you the most control, and the most work. Every other model trades some of that work for some of that control. The useful question isn't which model is best. It's which tradeoff you want.
Most therapists who take insurance end up in one of four setups:
- Solo private practice. Your business, your rules, your billing.
- Group practice. You join an existing practice as an employee (W-2) or contractor (1099).
- Telehealth platform. A company matches clients to you through its own app or system.
- Supported contractor network. You stay an independent contractor, and an organization runs credentialing, billing, and referrals for a specific population or payer mix.
Models vary a lot from company to company, so treat the patterns below as common, not universal.
How do the models compare?
| Solo practice | Group practice | Telehealth platform | Supported contractor network | |
|---|---|---|---|---|
| Clinical decisions | You | You, sometimes with practice policies on frequency or modality | You, sometimes with platform rules on session types or length | You |
| Schedule | You | Often set or approved by the practice | Varies; some require minimum hours | You |
| Caseload minimum | None | Common for W-2 roles | Varies | Depends on the network |
| Credentialing and billing | You or a billing service you pay | Practice | Platform | Network |
| Who carries denials | You | Practice, though some pay only on collected claims | Varies by contract | Depends on the contract |
| Referrals | You market yourself | Practice's intake | Platform matching | Network's intake |
| Exclusivity | None | Non-competes and non-solicits are common | Varies | Depends on the contract |
| Benefits | You buy your own | Possible with W-2 | Rare | None for 1099 |
What does solo practice really cost you?
Mostly time and risk. You keep the full fee, but you also do the credentialing, eligibility checks, claims, denials, marketing, and scheduling, or you pay someone to. Cash flow depends on how fast each payer pays. If a claim is denied or a client no-shows, that loss is yours.
For some therapists, that's worth it. Others find the business side takes the hours they wanted for clients or family.
What do group practices and platforms trade away?
They usually take admin off your plate in exchange for some control over your time. Common examples include a required number of weekly sessions, set office or evening hours, assigned clients, or pay that depends on what the practice collects. Some contracts also limit where you can work after you leave. See Are Non-Compete Clauses in Therapist Contracts Enforceable?
None of that is automatically bad. A W-2 group job with benefits and steady referrals is a good deal for many clinicians. The point is to know which terms you're accepting.
Where does a supported contractor network fit?
It's meant to sit between solo practice and a traditional group. You keep the independence of a contractor: your schedule, your caseload size, your clinical calls. The organization handles the business work tied to its payers and its client population.
The tradeoffs are real. You don't set the rate. Your referral flow depends on the network's demand in your state. And as a 1099 contractor, you get no employee benefits. Read the contract the way you'd read any other one, using questions to ask before joining a practice or platform.
How ValorWell handles this
ValorWell is a supported contractor network for therapists serving Veterans and their families. Here's how it lines up against the table:
- Clinical decisions: yours, including frequency, treatment approach, and discharge. No productivity targets override your clinical judgment.
- Schedule and capacity: you set your availability in the EHR, choose whether clients can book themselves, and turn new clients on or off whenever you want.
- Credentialing, authorizations, and billing: ValorWell does them.
- Denials: handled by ValorWell; they don't come out of your pay.
- Pay timing: weekly, for the sessions you documented that pay period.
- No-shows: where program rules allow it, the client is billed a reduced no-show fee and the full amount goes to you. VA Community Care clients can't be charged, so ValorWell limits how many sessions they can miss.
- Exclusivity: none. Keep your practice or other work.
- Leaving: any time, with enough notice that ValorWell can find your clients a new clinician.
Important limits
- No benefits. ValorWell therapists are 1099 contractors. Health insurance, retirement, and paid time off are on you.
- No guaranteed caseload. Referral volume depends on demand, eligibility, authorizations, and fit.
- Your own malpractice. ValorWell doesn't provide coverage.
- A specific population. The clients are Veterans, spouses, and children of Veterans, paid through CHAMPVA, VA Community Care, or the ValorWell Foundation. If you want a general caseload with commercial insurance, you'd keep that elsewhere.
- Telehealth. If you want to see clients in person, this model won't cover that part of your practice.