Kudos to Mark Cuban’s for making the direct contracts his company has negotiated publicly available, with clear rate information embedded in them. The contract is here.
By David Gaines
Analyzing Mark Cuban’s CostPlusWellness’ (MCCPW) Direct Contract with Texas Oncology.
Kudos to Mark Cuban’s for making the direct contracts his company has negotiated publicly available, with clear rate information embedded in them. The contract is here.
This level of transparency is rare in healthcare and gives plan sponsors and their partners an opportunity to better understand contracting and competitive positioning.
Because the MCCPW contract specifies reimbursement at 142% of Medicare for covered services at Texas Oncology, it provides a clear point for comparison. This information, combined with the available price transparency data, allows us to evaluate how national carrier rates stack up against the same provider.
For this analysis, we looked at two national carrier networks: Aetna Choice POS II and UHC Choice. We focused on drugs delivered under medical benefit (J-Codes) which are often the bulk of the cost for an oncology group like this one.
Methodology:
-We take a de-identified sample of Texas Oncology drug administration claims from our proprietary database
-We build a representative basket of services from that sample
-We queried carrier transparency data for Texas Oncology under Aetna Choice POS II and UHC Choice
-We simulate payment on those claims using that rate information
-We compare all results against the Medicare fee schedule
Results:
-UHC Choice: 137% of Medicare
-Aetna Choice POS II: 133% of Medicare
-MCCPW: 142% of Medicare
The MCCPW rate is competitive with the market, falling within roughly 3–7% of national carrier pricing in this example. While MCCPW’s rate is modestly higher than the two national carriers analyzed, directing volume to independent, non-hospital facilities like Texas Oncology is often meaningfully lower cost than hospital-based alternatives providing equivalent services.
It’s also worth noting that the MCCPW contract includes claims review and overpayment recovery provisions. Further, by direct contracting there are no ancillary fees (savings fees) or special clauses (anti-steering) that MCCPW has to abide by – both UHC and Aetna generally require use of their ASO to access the UHC Choice and Aetna Choice POS II networks.
These rights are rarely available to plan sponsors in traditional carrier arrangements and are not reflected when looking at headline reimbursement rates alone.
Additionally, accessing this provider outside of national carriers through the wrap networks available to independent TPAs is likely much more expensive on a purely rates basis.
This analysis is not meant to be critical of MCCPW. Quite the opposite: publishing real contracts is exactly the kind of transparency needed to allow objective analysis, informed decision-making, and ultimately lower healthcare costs. This is how the market gets more efficient, and MCCPW is doing important work.
Today’ homework reading assignment: Best Kept Secrets Never Are
