Cuban’s Mission to Fix Healthcare Economics
Mark Cuban has never hidden his drive to overhaul U.S. healthcare economics. Speaking on April 15 at the Becker’s Spring Chief Pharmacy Officer Summit in Chicago, he framed his motivation in blunt terms — taking on an industry that consumers widely resent and bending it toward transparency and affordability.
His earlier venture, Cost Plus Drugs, launched in 2022, set the blueprint. The online pharmacy sells generic medications at a flat 15% markup plus a $5 shipping fee. It publishes its full price list publicly and bypasses both traditional pharmacy benefit managers and wholesalers. That same transparency logic now drives his newest initiative — Cost Plus Wellness — a direct contracting platform reshaping how hospitals and health systems get paid.
What Is Cost Plus Wellness?
Cost Plus Wellness connects self-insured employers directly with healthcare providers through publicly posted contracts. Cuban describes it not as a conventional business but as an “open-source project.” Its goal is to give employers a replicable template for bypassing commercial insurers and negotiating care on transparent, predictable terms.
The platform eliminates several pain points that burden traditional payer-provider relationships. Specifically, it removes:
- Intermediaries and middlemen
- Spread pricing and hidden administrative fees
- Balance billing and prior authorization requirements
Furthermore, under platform contract terms, employers and third-party administrators must pay providers within 30 days of receiving a claim — a stark contrast to the slow, clawback-prone payment cycles common with major insurers.
As Cuban states on the platform’s website: “The biggest insurance companies have intentionally made this industry opaque. Every single contract has a confidentiality clause. The number one rule of healthcare contracts is that you can’t talk about healthcare contracts. Until now.”
How the Platform Works
Cost Plus Wellness currently lists 27 published contracts covering at least 9,200 providers and 193 facilities. Most are concentrated in the Dallas-Fort Worth metro area, though Cuban confirms the platform will continue expanding nationwide.
The contracts span a range of provider types — from single-specialty groups to independent physician associations. Dallas-based Baylor Scott & White Health, the largest nonprofit health system in Texas, was among the first major organizations to sign on.
Additionally, the platform distinguishes between two contract categories. The first involves contracts directly negotiated by Cost Plus Wellness. The second, called “community contracts,” are self-published by providers using the platform’s template. Importantly, insurers are explicitly barred from using any contracts on the platform. Cuban argues that large commercial payers underpay, pay late, execute clawbacks, and fail to cover employee out-of-pocket costs — making them poor partners for providers.
Cuban’s Pitch to Hospitals
Cuban’s central argument to health systems is a profitability one, and it challenges conventional assumptions about payer mix. He urges hospital leaders to conduct a detailed cost and profitability analysis by insurance carrier. His contention: the biggest commercial payers are often the least profitable relationships once administrative burden, late payments, denials, clawbacks, and legal costs are fully accounted for.
“Don’t be afraid by the daily patient count because you think you’ve got all this capex and you need bodies coming through the door,” he said. “Just making sales and losing money is not making money.”
Rather than advocating a total break from commercial insurance, Cuban recommends a practical starting point. He encourages hospitals to identify large self-insured employers whose workers they already treat and approach those employers directly. The pitch is straightforward: demonstrate the savings available through a direct contract, using real claims data the health system already holds.
“You don’t like insurance companies,” he noted. “And you know what? Neither do they.”
The Broader Direct Contracting Landscape
Direct contracting is gaining momentum across the U.S. healthcare system, driven by mounting payer-provider friction and rising employer healthcare costs. According to KFF data from 2025, 67% of covered workers nationally are enrolled in self-funded plans — including 80% of employees at large companies. This growing self-insured employer base makes direct contracting an increasingly viable route to cost savings.
The trend is visible in major deals as well. In December, Northwell Health finalized a direct contracting arrangement with a union health fund representing 100,000 building service workers in New York City. That deal, structured to make Northwell the most affordable academic medical center in the state for fund members, was described as the largest of its kind.
Meanwhile, major insurers are not standing still. Several large payers have begun rolling out tiered and preferred network strategies to retain employer relationships while offering more pricing flexibility. Moreover, a growing wave of litigation now targets health plans and TPAs, with employers and employees seeking access to claims data they argue is owed to them under ERISA fiduciary standards.
Why This Matters for Self-Insured Employers
For self-insured employers, Cost Plus Wellness offers a tangible alternative to the opacity and cost-shifting that define traditional insurance arrangements. Cuban notes that small- to mid-sized self-insured companies have been the earliest adopters of the platform. These employers, often squeezed between rising premiums and shrinking margins, stand to benefit most from transparent, direct pricing with providers.
Ultimately, Cuban’s message to both employers and health systems is the same: the insurance company is not your customer, and it may not be your ally either. Direct contracting, done transparently and at scale, offers a path to a healthcare economy where providers get paid fairly and employers pay what care actually costs.
“It can be done easier,” he acknowledged. “But I’m not going to say it’s going to be easy, because you have to change behaviors.”
