Mark Cuban disrupted pharmaceutical pricing in 2022 with Cost Plus Drugs, a public benefit corporation that charges a flat 15% markup on generics and posts its full price list publicly, bypassing pharmacy benefit managers and intermediaries entirely.
Four years later, he is running the same playbook on how providers get paid, and ASCs are at the center of the experiment.
His platform, Cost Plus Wellness, connects self-insured employers directly with providers through publicly posted contracts with no insurers in the middle, no prior authorization requirements and no hidden fees. The providers leading adoption are predominantly ASCs and physician groups.
Mr. Cuban described the platform as an “open-source project” rather than a business at Becker’s Spring Chief Pharmacy Officer Summit on April 15. The platform distinguishes between contracts it has directly negotiated and “community contracts,” which are those self-published by providers using a Cost Plus Wellness template. Regardless of contract type, the platform bars insurers from using any of its contracts.
The pitch to ASCs and physician practices is direct: Once denials, clawbacks, late payments, and legal and administrative costs are fully accounted for, a facility’s highest-volume commercial payer relationships may also be its 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 at the summit. “Don’t be afraid by the daily patient count because you think you’ve got all this capacity and you need bodies coming through the door. Just making sales and losing money is not making money.”
The platform lists 37 published contracts covering at least 9,200 providers and 193 facilities, concentrated largely in the Dallas-Fort Worth area, with Dallas-based Baylor Scott & White Health the largest and most prominent health system to sign on.
Commercial rates average around 196% of Medicare fee-for-service, while Medicare pays ASCs only 53% to 56% of what it pays hospital outpatient departments, according to 2025 Milliman data. That reimbursement structure makes commercial payer relationships disproportionately important to ASC margins, and disproportionately damaging when those relationships are unprofitable.
The ASC model is already built around cost efficiency and streamlined care delivery. Direct contracting with self-insured employers that have strong incentives to steer patients toward lower-cost settings maps cleanly onto what ASCs already offer. Where a hospital system selling direct employer contracts is trying to compete with its own insurance partners, an ASC has no such conflict.
Cost Plus Wellness is not operating in isolation. The direct employer contracting movement has been building for years, driven by the same employer frustration with healthcare costs that Mr. Cuban is pitching against. For example, Wellbridge Surgical, an Indianapolis-based free-market ASC, has built its model around all-inclusive bundle pricing directly with self-insured employers and claims 50% to 60% savings compared to what hospital systems offer through direct employer contracts.
Mr. Cuban’s platform has a policy barring insurers from using any of its contracts, which is a deliberate firewall that makes the platform incompatible with traditional managed care contracting and positions it explicitly as an alternative, not a supplement.
The platform’s current geographic concentration in Texas limits its immediate reach for most ASC operators. But the model’s logic is similar to what has already worked in pharmaceuticals and what a growing number of ASC operators are building independently.
Whether Cost Plus Wellness scales nationally or remains a regional proof of concept depends on employer adoption. The platform’s open-source structure means any provider can publish a contract. The question is whether enough employers in enough markets are ready to shop that way.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.