Mark Cuban's Cost Plus Wellness Is Bringing ASCs Into Direct Contracting

Mark Cuban did to prescription drug pricing what most of the industry said couldn't be done: he posted the prices publicly, stripped out the middlemen, and found customers. Cost Plus Drugs launched in 2022 with a flat 15% markup over cost and a $5 shipping fee. It now sells more than 6,000 medications and moved directly into health systems in 2024.

He's running the same playbook on provider contracting — and the early movers are ambulatory surgery centers and physician groups, not hospitals.

What Cost Plus Wellness Actually Is

Cost Plus Wellness connects self-insured employers directly with healthcare providers through publicly posted contracts. The platform currently lists 27 contracts covering 9,200+ providers and 193 facilities, concentrated in Dallas–Fort Worth but expanding nationally. Baylor Scott & White, the largest nonprofit health system in Texas, was among the first to sign on.

The contracts are posted in two categories:

• Platform contracts — negotiated directly by Cost Plus Wellness
• Community contracts — self-published by providers using the platform's standard template

Cuban describes it as an open-source project rather than a business. It is currently free. Insurers are explicitly barred from using any contracts on the platform.

Three things make the contract terms materially different from standard commercial arrangements:

1. No prior authorization — procedures are priced and posted; employers pay what's posted
2. No balance billing — the contracted rate is the rate
3. 30-day payment requirement — employers and their TPAs must pay within 30 days of receiving a claim

That last point matters more than it sounds. Most commercial payers operate on payment timelines that stretch well beyond 30 days, with clawbacks, reprocessing, and audit-driven adjustments extending the real settlement window further. Providers on Cost Plus Wellness trade payer volume for payment predictability.

Why ASCs Are Leading

The Becker's ASC piece is worth reading closely because it signals something about adoption dynamics. ASCs are moving faster than hospitals for reasons that make structural sense:

Lower administrative overhead to begin with. An independent ASC isn't running a complex payer mix across dozens of service lines. A single well-priced direct contract can represent a meaningful share of revenue without requiring extensive internal restructuring.

Procedure-level pricing is already how ASCs think. A surgeon performs a knee arthroscopy. It costs what it costs. That's a more natural fit for transparent, posted pricing than a full acute-care hospital with variable case complexity across thousands of DRGs.

Insurer relationships are already adversarial. ASCs have watched reimbursement compression from commercial payers for years. The Medicare-plus or transparent cost-based pricing Cuban offers is often higher than what commercial payers are paying — not lower.

Employers are already using ASCs for savings. Many self-insured employers have embedded ASC directives in their plan design (steering employees toward lower-cost surgical settings). Cost Plus Wellness formalizes that relationship with a direct, published contract instead of routing through a carrier.

Cuban's Pitch to Health Systems

Cuban's argument to hospital and ASC leadership is a profitability analysis exercise, not an ideological one.

His recommendation: pull your claims data, break out your cost and payment by insurance carrier, and calculate what each payer relationship actually returns after accounting for administrative cost, denials, clawbacks, delayed payment, and legal exposure. His contention is that major commercial payers — the ones sending the most volume — are often the least profitable relationships when fully loaded costs are factored in.

"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 practical starting point for providers isn't a wholesale departure from commercial insurance. It's identifying the large self-insured employers whose employees they already treat and approaching those employers directly — using real claims data the provider already holds to demonstrate the savings case.

The Market Context

This isn't a fringe play. According to KFF data from 2025, 67% of covered workers nationally are in self-funded health plans. At large employers (500+ employees), that number is 80%. The addressable market for direct contracting is the majority of commercially insured Americans.

That's also why large payers are paying attention. Several have begun rolling out tiered and preferred network structures to retain employer relationships while offering more pricing flexibility. And ERISA litigation targeting TPAs and health plans for failure to share claims data is increasing — employers are becoming more aggressive about asserting fiduciary rights over their own plan data.

Cost Plus Wellness is early. Twenty-seven contracts in DFW is a proof of concept, not a national infrastructure. But the contract templates are public, the model is replicable, and Cuban's stated intent is to expand nationally.

What Self-Insured Employers Should Watch

If you're a self-insured employer and your TPA is routing your surgical claims through a commercial payer network, you're paying network fees for access to rates that may or may not be competitive with what you could negotiate directly.

Three questions worth asking your TPA or benefits advisor:

1. Which ASCs do our employees already use most? That's your starting point for a direct contract conversation.
2. What are we actually paying per procedure at those facilities, net of all fees? Pull the claims data. Most TPAs can produce this.
3. Is there a confidentiality clause in our current network agreement preventing us from seeing or sharing those rates? If yes, that's the Cuban problem statement in your own plan.

The Cost Plus Wellness model won't work for every employer or every market. It requires cash-like payment terms and a willingness to operate outside the traditional TPA-carrier relationship. But for self-insured employers with the financial bandwidth to pay on 30-day terms and the claims volume to negotiate meaningful volume commitments with local ASCs, it's a live option — not a hypothetical one.

Bottom Line

The ASC adoption pattern tells you something about where direct contracting gains its first real traction: settings where procedure pricing is deterministic, payer relationships are already strained, and employers are already steering volume. Self-insured employers with surgical spend concentrated in a handful of facilities should be running the math now, not after the market moves around them.

Track active employer–provider direct contracting deals: directcontract.co