Direct Contracting Is Starting to Look Like Infrastructure, Not an Experiment

Direct contracting has spent years being described as a custom strategy for unusually sophisticated self-insured employers.

The latest growth of Cost Plus Wellness suggests a different possibility: direct contracting may be starting to develop reusable infrastructure.

Cost Plus Wellness currently lists 62 public contracts, with 36 identified as being used by Mark Cuban Companies in Texas. The inventory now spans physician groups, health systems, ambulatory surgery centers, behavioral health, imaging, primary care, specialty care, virtual care, and service providers.

Four more provider contracts were dated September 1, 2026 alone: Watauga Orthopaedics, Golden Life Wellness Center, hom neuro, and Dallas Pain Consultants.

The number matters. But the structure matters more.

The important innovation is not another narrow network

Traditional employer direct contracting usually begins with a specific employer and a specific provider negotiating from scratch.

That works, but it does not scale easily. Every new relationship creates another contracting exercise, another set of rates, another implementation workflow, and another operational dependency.

Cost Plus Wellness is testing a different model.

The contracts are public. Employers can review the terms and rates. The site explicitly tells employers they can download a contract and use it with providers. It also publishes standard agreement templates for employers and TPAs.

That begins to separate the contract architecture from the individual employer negotiation.

If that model works, direct contracting becomes less like a bespoke consulting project and more like a set of reusable rails.

What 62 contracts tell us

The current inventory is still small relative to a national carrier network. That is not the right comparison.

The more useful question is whether employers can assemble enough high-value coverage to meaningfully alter where expensive care is purchased.

The 62 contracts show several things already.

Specialty breadth is expanding

The list is no longer concentrated in one service category. It includes oncology, cardiology, orthopedics, surgery centers, imaging, behavioral health, pediatrics, allergy, dermatology, endocrinology, rheumatology, urology, primary care, telehealth and other services.

That is important because employer direct contracting becomes more useful as it moves from one-off centers of excellence toward a portfolio of addressable services.

Geography is starting to expand beyond Dallas

The platform remains heavily associated with the Mark Cuban Companies experience in Texas, but contracts now include providers in Tennessee, Virginia, Oklahoma, Michigan, Wisconsin, North Carolina, Colorado, Indiana, Iowa, Arkansas and other markets.

A nationally relevant direct-contracting layer does not need to recreate a carrier network overnight. It needs enough local density in the right services to create an alternative purchasing channel.

Standardization is visible

Cost Plus Wellness reports 53 standard contracts and 9 custom contracts. It also categorizes 55 as fee-for-service, four as subscription arrangements and three as unspecified.

That standardization may be the most important scaling signal.

A market in which every contract is custom remains services-heavy. A market in which most relationships can use common structures has a better chance of becoming infrastructure.

The operating model matters as much as the rates

The platform's public materials describe several operational features designed to remove familiar friction from direct contracting.

Providers are paid the negotiated rate without patient collections. Employers and TPAs are expected to pay clean claims within 30 days. Contracts publish pricing and terms upfront. Providers opt into new employer relationships rather than being automatically bound to every employer using the platform.

Those details matter because a direct contract can fail even when the negotiated price is attractive.

Claims routing, provider identification, member communication, eligibility, payment timing, stop-loss treatment, and TPA execution can determine whether the contract actually gets used.

The next phase of competition in direct contracting may therefore be less about who has the lowest headline price and more about who makes the contract operationally easy to deploy.

Employers do not need 100% network replacement

One reason direct contracting has often looked intimidating is the assumption that an employer must build an entire provider network.

That is rarely necessary.

A more practical strategy is to identify service lines where three conditions overlap:

1. meaningful spend concentration;
2. large price variation or avoidable facility cost;
3. enough member volume to support steerage.

Orthopedics, imaging, infusion, surgery, oncology, primary care, behavioral health, and certain specialty services can fit that profile depending on the workforce.

The traditional carrier network can remain the broad access layer while direct contracts become a preferred purchasing channel for selected care.

That makes a growing public contract library potentially much more useful than its absolute provider count suggests.

What employers should watch next

The contract count is one metric. More important indicators will be:

• how many contracts are actively used by employers other than Mark Cuban Companies;
• how quickly employers can implement a published contract with an existing TPA;
• whether contract density grows in specific metro areas;
• utilization and steerage into the contracted providers;
• measured savings relative to the employer's incumbent network rates;
• quality and outcomes reporting;
• expansion from physician and ASC contracts into broader specialty-care ecosystems.

The crucial test is whether publishing a contract actually lowers the cost of creating the next employer-provider relationship.

If it does, the market changes.

Direct contracting is becoming a distribution problem

The early direct-contracting question was: Can an employer negotiate a better deal directly with a provider?

The answer has often been yes.

The harder question has been: Can thousands of employers do it without rebuilding the process from scratch?

Public contracts, reusable templates, TPA agreements, transparent rates, and a searchable provider inventory are all attempts to solve that second problem.

That is why the latest Cost Plus Wellness growth is worth watching.

Sixty-two contracts do not make a national network.

But they may be evidence that direct contracting is beginning to acquire something it has historically lacked: repeatable infrastructure.

Sources: Cost Plus Wellness public Contracts directory, Agreement Templates, FAQ and employer/provider guidance, accessed September 5, 2026.