The claim that started it
Mark Cuban Companies (MCC) hit the same problems every self-funded employer hits: opaque contracts, escalating costs, and negotiated rates that somehow ran higher than what a walk-in patient would pay.
The defining moment came on a single emergency room claim. The carrier's network required MCC to pay over $45,000 for one ER visit. The same hospital's public price-transparency files showed that the same carrier had negotiated $14,000 for the identical services through its fully-insured book. Same hospital, same services, same carrier, and the self-funded employer was paying roughly three times the price.
Rather than trying to work through the insurance carrier (that wasn't really providing insurance), MCC went straight to the providers and contracted with them directly. Those agreements became the foundation of Cost Plus Wellness, and they are now published in full on this site.
The three-tier plan design
MCC organizes providers into three tiers:
| Tier | Providers | Member cost-share |
|---|---|---|
| Tier 1 | Cost Plus Wellness providers | $0 out-of-pocket. No deductible, copay, or coinsurance. |
| Tier 2 | Wrap (PPO) network | Standard plan benefits |
| Tier 3 | Out-of-network | Standard out-of-network terms |
The $0 Tier 1 provides any easy-to-remember incentive for the member. When members are choosing a provider, "free" is the easiest signal to remember and act on. A $0 Tier 1 isn't required to use these contracts; plans can structure cost-share however they want, as long as the plan, not the provider, collects any member responsibility. Providers under a CPW contract never chase patients for money.
The vendors behind the plan
Direct contracting only works if the plan's vendors are set up to support it. MCC's stack looks like this:
- Sage TPA (an independent TPA) to pay claims and help members find Tier 1 providers.
- Claimsbridge (a repricing engine) for centralized repricing across groups.
- Stop-loss coverage that recognizes CPW rates.
- A national PPO wrap network that allows direct-contract carve-outs.
- A transparent, pass-through PBM for pharmacy.
- Embedded care navigation to guide members to the right providers.
MCC also licenses provider-quality data: outcomes data from SurgeonCheck and appropriateness data from GAM, used to steer members toward high-performing providers.
Lessons from running it
A few things that weren't obvious going in:
- Adoption is a member-engagement problem, not a contracting problem. Once the contracts exist, the real work is communication, in plain language.
- Pre-visit advance work pays for itself. Calling provider offices before appointments helps resolve almost all post-visit billing disputes.
- Provider front desks need a script. Staff need a clear, simple explanation of how a self-funded, directly-contracted plan pays, so claims don't get mishandled.
- Anti-steering and gag clauses kill the model. Check every wrap network and stop-loss vendor for them upfront.
- Centralized repricing scales better than per-TPA setups. As more groups adopt the contracts, repricing in one place beats rebuilding it inside each TPA.
Putting it to work
The contracts MCC negotiated are published in full. Browse the contracts to see real pricing and terms, read Cost Plus Wellness for Employers for the full employer playbook, or start an inquiry and we'll help you put them to work.