Mark Cuban has never been subtle about what fuels his motivation to upend U.S. healthcare economics.
“What’s more fun and more exciting than taking an industry that everybody hates, the economic side of healthcare … and to be able to try to at least make those steps to change it, to make people’s lives better, and to kick the biggest companies in the country’s ass doing it,” he said April 15 at the Becker’s Spring Chief Pharmacy Officer Summit in Chicago.
In 2022, Mr. Cuban co-founded Cost Plus Drugs, an online pharmacy that sells generic medications at a 15% markup and flat $5 shipping fee, posting its full price list publicly and bypassing traditional pharmacy benefit managers and wholesalers. Now he’s directing the same transparency logic toward how hospitals and health systems get paid through “Cost Plus Wellness,” a direct contracting platform that connects self-insured employers with providers through publicly posted contracts.
“This is meant to offer a template to employers to take advantage of the savings from direct contracts,” he said.
The platform, which is described as an “open-source project” rather than a business, has no intermediaries, no spread pricing, no balance billing, no prior authorization requirements and no hidden administrative fees. Under the platform’s contract terms, employers and third-party administrators are required to pay within 30 days of receipt of a claim.
“We started Cost Plus Wellness because you are overpaying for healthcare,” Mr. Cuban notes on the platform’s website. “The biggest insurance companies have intentionally made this industry opaque. In fact, 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.”
The platform currently lists 27 published contracts covering at least 9,200 providers and 193 facilities – predominantly in the Dallas-Fort Worth metro area – with Mr. Cuban confirming more contracts will continue to be added throughout the country. The contracts cover a range of provider types, including single- and multispecialty groups and independent physician associations. Dallas-based Baylor Scott & White Health, the largest and most prominent organization on the platform, was the first major health system to sign on.
The platform also distinguishes between contracts it has directly negotiated and what it calls “community contracts,” which are self-published by providers using a Cost Plus Wellness template. Regardless of contract type, Mr. Cuban said the platform has a policy barring insurers from using any of its contracts.
“When you go to the site, we say specifically that insurers cannot use these contracts and we tell them exactly why,” he said. “They underpay. Late pay. Claw back. Don’t cover the employee out of pocket among other things. These are what make these contracts exciting for providers. They don’t have to fight to get paid.”
His pitch to hospitals? Once administrative issues, late payments, clawbacks, denials and legal costs are fully accounted for, the largest commercial payer relationships may be the least profitable.
“If you literally did a cost analysis and a profitability analysis by insurance carrier, the biggest ones are where you’re going to be losing the most money,” Mr. Cuban said. “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. Just making sales and losing money is not making money.”
His argument comes at a time when payer-provider friction has become a structural feature of the healthcare system, with out-of-network disputes between major health systems and insurers growing more frequent and more public in recent years, especially as pressure from employers continues to grow over rising healthcare costs.
According to KFF, 67% of covered workers nationally are enrolled in self-funded plans as of 2025, including 80% of employees at large companies. Mr. Cuban said small- to mid-sized self-insured companies have largely been the first adopters of Cost Plus Wellness.
In December, New Hyde Park, N.Y.-based Northwell Health and a union health fund representing 100,000 building service workers in the New York City area finalized what was described as the largest direct contracting arrangement of its kind, a deal structured to make the health system the most affordable academic medical center in the state for the fund’s members. Major payers, meanwhile, have begun rolling out new preferred and tiered network strategies designed to retain employer relationships while offering more pricing flexibility.
The friction is also increasingly playing out in the courts. Over the past several years, a growing wave of litigation has targeted health plans and TPAs from employees and employers seeking access to claims data they argue they are entitled to under ERISA fiduciary standards.
For health systems willing to engage with his proposition, Mr. Cuban’s recommended starting point is not a full break from commercial payers, but instead a direct conversation with large self-insured employers whose workers the system already sees.
“You guys know, from any given employer, what patients you’ve seen,” he said. “Go and sit down with them and say, ‘let’s talk about all these patient experiences and what you paid for them, because I can save you money.’ Because you know what you both have in common? You don’t like insurance companies.”
“It can be done easier, but I’m not going to say it’s going to be easy, because you have to change behaviors,” he added. “But the insurance company is not your customer.”
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