Revolutionizing Employee Healthcare | Dan Pascone with Mark Fox | Podcast # 03

Posted on May 9, 2025 by Dan Pascone

Answer Box: TL;DR

Employer healthcare costs are exploding because the system pays middlemen more when costs go up—and most CFOs can’t even see where their dollars are going. In this episode, Dan talks with healthcare innovator Mark Fox of CBG about how his firm builds custom, self-funded health plans that connect employers, providers, and employees directly—removing misaligned intermediaries, unlocking real data, and guaranteeing measurable savings. They cover why U.S. healthcare spends ~20% of GDP yet ranks poorly on outcomes, how to use claims data to attack high-cost areas like ER usage, what it means to offer a guaranteed ROI on benefits, and how AI, mentors, and bold thinking shape Mark’s approach to business and leadership.

Key Takeaways

What CBG does: CBG designs custom employer health plans from scratch, directly linking the provider (doctor/hospital) and the patient, and removing unnecessary middlemen. The goal: better care at dramatically lower cost.
How Mark got into the space: Like many in insurance, he arrived “by accident” while looking for real solutions to America’s healthcare problem, not just another brokerage gig.
Ideal client profile:
- CFOs, CEOs, and HR leaders who know their healthcare spend is unsustainable and unpredictable.
- People who are tired of big carriers hiding data and saying “HIPAA” as a shield.
- Leaders who want to treat benefits as a strategic lever, not a box to check or a “speed bump” at annual renewal.
Who is NOT a fit: Employers who just hit “renew” every year, see healthcare as a nuisance, and aren’t interested in changing the model.
3-step engagement model:
1. “Can we help you?” analysis: CBG reviews the plan from a high level, compares 5-year cost trajectory to industry trends and CBG results, and quantifies potential savings vs “budget dust.”
2. Build phase: For a small consulting fee, they design a fully custom plan (not just shopping the census with carriers), tailored to workforce location, goals, and risk tolerance.
3. Implement & manage: If implemented, CBG manages the plan on a per-employee-per-month fee and guarantees the savings metrics they modeled.
Unique guarantee structure:
- If CBG doesn’t hit the savings they projected, they refund the consulting fee.
- If they do hit the savings and the employer implements the plan, they also refund the fee because they’re compensated via PEPM to run the plan.
- Mark notes almost nobody in healthcare uses words like “guarantee” or “certainty”—most say “it depends.”
Why the current system is broken:
- The U.S. spends nearly 20% of GDP on healthcare, about 2x other developed countries, yet ranks 37th in quality per WHO—just behind Costa Rica.
- Traditional brokers and intermediaries earn more when premiums go up, so they’re paid more for doing a worse job.
- Example: a surgeon who leaves a tool in a knee gets paid again to correct the mistake—aligned with volume, not value.
Aligned incentives vs misaligned incentives:
- Large brokerages work on commission; bigger renewal = bigger paycheck.
- CBG works on a fee-based, aligned model, sitting on the same side of the table as the employer: when the employer wins, they win.
- They remove “fluff” and high-cost middle layers, then realign incentives around quality and efficiency.
Biggest challenge #1 – Data access:
- Carriers often refuse to share meaningful claims data, hiding behind HIPAA.
- Mark calls this “a load of crap” because employers have a fiduciary duty to ensure plan assets are spent prudently.
- Without data, you can’t shop, benchmark, or fix anything.
Biggest challenge #2 – Acting on data:
- Even when employers have data (from wellness vendors, TPAs, etc.), many do nothing with it.
- CBG uses data to identify the largest cost drivers and then plugs in targeted solutions—specialty meds, oncology, high-cost imaging, ER usage, etc.
Example – Emergency room costs:
- One client had huge ER spend, which is hard to pre-negotiate because emergencies are unplanned.
- CBG implemented a strategy that cut ER costs by 80%, while employees paid nothing out of pocket when using the smarter path.
- They use a carrot-and-stick model: employees keep full freedom of choice (standard deductibles/copays if they ignore guidance), but pay $0 when they follow cost-effective options.
Client size & evolution:
- CBG focuses on employers with 100+ employees.
- The model works for groups as small as 30 lives, and CBG still has legacy clients in the 30–50 range saving significant money.
- Moving upmarket increased negotiating power with hospitals and expanded the solution set.
How clients find CBG: Primarily through:
- Marketing outreach (ads, campaigns)
- Client referrals from satisfied employers
Referral & channel partners:
- They partner with non-traditional referrers like a traveling nurse, a preacher with a large network, and attorneys who understand healthcare law and politics.
- Surprisingly, hospitals themselves can be great clients and partners—CBG fixes the hospital’s own plan, then helps them become a local healthcare hub for employers.
- This is especially powerful in rural areas where small hospitals are getting crushed by large non-profit systems; CBG’s approach helps drive revenue to the local hospital while saving the community money.
Industry outlook (5–10 years):
- Talk of single-payer will persist but likely won’t materialize for complex political reasons.
- Transparency is increasing, but employers often don’t know how to use the new data.
- Future success hinges on systematically attacking the frequency and severity of high-cost claims (e.g., cancer, specialty drugs) with targeted solutions.
- Mark believes that if we solve for frequency + severity, we solve healthcare in America.
Biggest personal/business challenge:
- Being perceived as “too outside the box” or “too innovative.”
- Early on, employers didn’t want to be the “guinea pig” for a new model.
- CBG overcame this by accumulating years of real results—savings, better benefits, improved care—and by offering guaranteed outcomes to de-risk adoption.
Personal tools & habits:
- Mark is a heavy AI user and calls it his must-have tech tool besides phone and computer.
- He uses ChatGPT and other models daily for organization, learning, and automating repetitive tasks.
- Within CBG, AI helps analyze support tickets, summarize issues, and suggest replies, freeing staff to spend more time talking directly with clients.
- He warns that if you’re still working and not using AI, “you will be left behind or your job will get replaced.”
Books & mentors:
- Recent favorite: Extreme Ownership by Jocko Willink & Leif Babin, and its sequel The Dichotomy of Leadership.
- Also cites the 80/20 rule as crucial for productivity and focus.
- Stresses the importance of getting the right mentors—in person or via books—as early as possible.
Fun bucket-list story: One of Mark’s bucket list items was to be invited onto a yacht by a stranger. While at a waterfront restaurant with his wife, he met professional tennis players who pulled up in a large yacht and invited them aboard—bucket list achieved.
Future milestones:
- He wants to eventually launch a second company in a different industry.
- He’s waiting until CBG can run 90–95% on its own, which he estimates will take another 3–5 years.
Advice to younger self: Get a mentor faster. Humble yourself, stop assuming you know everything, and learn from those who’ve already built what you’re trying to create.
How to connect with Mark: Listeners can reach him via the CBG website and email shared at the end of the episode; Dan notes these will be linked in the show notes.

Key Moments

00:02 – Sponsor intro. The show opens with Tailored Wealth as the sponsor, “helping business leaders live their version of a rich life.”
00:02–00:32 – Show framing. The announcer and Dan reiterate the podcast’s purpose: cut through financial noise and help business leaders make smart, confident money decisions.
00:32–00:51 – Meet Dan & Tailored Wealth. Dan introduces himself as the founder and CEO of Tailored Wealth and sets the context for another episode focused on making sense of money.
00:51–01:05 – Introducing Mark Fox. Dan welcomes Mark Fox, owner and president of CBG, noting that Mark operates in the healthcare space and is doing innovative work.
01:05–01:24 – How Mark got into healthcare. Mark flips the typical intro and starts with his backstory, explaining that most people land in insurance “by accident.” He was originally seeking a solution for Americans’ healthcare problems, which led him into this space.
01:44–02:04 – What CBG does (high level). Mark explains that CBG builds custom health plans for employers, aligning providers and patients while removing unnecessary middlemen to increase quality and reduce cost.
02:04–02:24 – Impact focus. He emphasizes that their work is changing the landscape of healthcare, positively impacting both employers and the employees’ pockets.
02:24–02:46 – Ideal client personas. Mark describes his ideal contacts as CFOs, CEOs, and HR directors who recognize their healthcare spend is unsustainable and unpredictable and are frustrated by carriers hiding data.
02:46–03:25 – Who’s not a fit. He distinguishes between change-seeking leaders and those who view healthcare as a “speed bump” and simply sign renewals each year; CBG is not for the latter group.
03:25–03:42 – Starting the process: “Can we help?” CBG begins with a macro-level analysis of the employer’s current plan, comparing the 5-year trajectory to both industry norms and CBG results to quantify potential savings.
03:42–04:27 – Build phase details. If savings look meaningful, CBG enters a build phase under a letter of engagement, charging a small fee to construct a custom plan from the ground up, rather than just shopping the census to carriers.
04:27–05:06 – Guaranteeing results. Mark explains that CBG guarantees the savings metrics. If they miss, they refund the consulting fee. If they hit and the client implements, they also refund the fee and then charge a PEPM to manage the plan—no commission.
05:06–05:30 – Why guarantees are rare. He points out that most of the industry never uses words like “certainty” or “guarantee” because their compensation structure depends on healthcare costs rising.
05:30–06:14 – The macro problem: U.S. healthcare. Mark cites that the U.S. spends nearly 20% of GDP on healthcare and ranks 37th in quality, just behind Costa Rica, showing we’re not getting what we pay for.
06:14–06:49 – Misaligned incentives in traditional brokerage. He explains how large broker firms work on commission and actually get paid more for higher renewals, which is misaligned with employers’ interests.
06:49–07:33 – CBG’s 180° business model. Because CBG doesn’t work on commission and isn’t beholden to shareholders, they can strip out costly intermediaries and realign incentives around employer and employee value.
07:33–08:23 – Challenge #1: data & HIPAA smokescreens. Mark calls out big carriers for claiming HIPAA prevents them from sharing useful data—something he says is “a load of crap,” given employers’ fiduciary duty to monitor plan assets.
08:23–09:16 – Fiduciary responsibility & why data matters. He likens healthcare fiduciary duties to investment oversight: if you knew what you were spending on, you could shop it, negotiate, and choose better partners; without data, you’re blind.
09:16–09:35 – Challenge #2: acting on data. Mark notes that many employers get data through wellness programs but then do nothing with it, essentially watching from the sidelines.
09:35–10:21 – Turning data into action (ER example). He shares a case where CBG saw high ER costs and implemented a solution that cut ER costs by 80% while keeping employee out-of-pocket at zero for guided usage.
10:21–10:40 – Carrot and stick design. Mark describes their model where employees maintain freedom of provider choice but face standard cost-sharing when they ignore guidance and pay $0 when they follow recommended, efficient options.
10:40–10:56 – How clients discover CBG. New clients typically come through marketing campaigns or referrals from existing clients.
10:56–11:43 – Client size and moving upmarket. CBG now focuses on groups with 100+ employees (though the strategy can work for as few as 30) because larger groups open more solution options and leverage in hospital negotiations.
11:43–12:31 – Referral partners & creative channels. Mark talks about referral partners including a traveling nurse, a preacher, and legal professionals who understand health policy and send prospects his way.
12:31–12:56 – Hospitals as clients. He explains that hospitals themselves can be impactful clients—CBG fixes the hospital’s internal plan and then helps local employers source care there, revitalizing rural hospitals under pressure from large non-profits.
12:56–13:36 – Industry trends & single-payer talk. Mark acknowledges the ongoing political chatter about single-payer but states it’s unlikely to materialize, given the complexity of the system and vested interests.
13:36–14:11 – Staying ahead in a shifting industry. CBG stays in the trenches, solving new issues as they arise and pivoting solutions as the market changes, particularly around transparency and targeted cost mitigation.
14:11–14:48 – Attack the right problems. Mark emphasizes that the key is not transparency alone but knowing how to mitigate the frequency and severity of high-cost claims like cancer and specialty drugs.
14:48–15:08 – Big-picture thesis. He argues that solving for frequency and severity of claims is the path to solving healthcare in America.
15:08–15:29 – Personal challenge: being “too innovative.” Mark describes his biggest challenge as being perceived as too outside the box; early prospects didn’t want to be the first to try something so different.
15:29–16:03 – Overcoming skepticism with results. As CBG gathered more years of data—showing cost savings, better benefits, and improved employee experience—they gained credibility and could scale more easily.
16:03–16:21 – De-risking with guarantees. Their no-lose guarantee (“no duh” business proposition) helps hesitant employers move forward without feeling like guinea pigs.
16:21–16:55 – Lightning round intro. Dan transitions into the lightning round, asking quickfire questions to get to know Mark personally.
16:55–17:16 – Coffee, dogs, and must-have tech. Mark chooses coffee over tea, dogs over cats, and names AI as the non-phone, non-computer tool he can’t live without.
17:16–17:42 – Quotes & mentors. Asked for a favorite quote, Mark instead highlights the importance of mentors—both in person and via books—as the real driver of his success.
17:42–18:16 – Favorite book(s). He cites Extreme Ownership as a standout and mentions he’s currently reading The Dichotomy of Leadership, plus referencing the 80/20 principle as a key concept.
18:16–19:01 – Productivity & AI. Mark shares that he once struggled with organization, but now leverages AI heavily to stay organized, automate tasks, and learn faster.
19:01–19:42 – The AI adoption warning. He quotes a stat that AI may replace a third of transactional jobs in the next five years and bluntly says that if you’re not using AI and you’re not retired, you risk being left behind.
19:42–20:25 – AI at CBG. Mark explains how CBG uses AI to summarize client support tickets and suggest responses, which agents then tailor, allowing more time for live client interactions.
20:25–21:28 – Bucket list: stranger’s yacht. He shares his bucket list story: getting invited onto a stranger’s yacht (in this case, pro tennis players), persuading his wife to go along, and enjoying an impromptu party onboard.
21:28–22:16 – Future goal: second company. Mark talks about his desire to start a second, unrelated company once CBG is largely self-sustaining (90–95% running without him).
22:16–23:41 – Advice to younger self. His advice: get a mentor sooner, humble yourself, and don’t learn everything the hard way. He reflects on his earlier traditional agency, which took longer to grow than it might have with guidance.
23:41–24:19 – How to connect. Mark gives his website and email so listeners can reach out to explore working with CBG.
24:19–24:34 – Closing. Dan thanks Mark for his time, insights, and vulnerability, then wraps the episode, encouraging listeners to keep sharpening their strategy and making their money work as hard as they do.
24:34–end – Post-recording banter. Dan and Mark share some casual remarks about the conversation, including Mark apologizing for momentarily losing his train of thought.

Episode Summary

In this episode of Making Sense of Your Money, Dan speaks with Mark Fox, owner and president of CBG, about how employer-sponsored healthcare can be radically redesigned to improve quality and lower costs. Instead of accepting ever-rising premiums and opaque data from big carriers, CBG helps employers build custom health plans from the ground up that realign incentives and give leaders control over one of their largest budget items.

Mark starts by sharing how he “fell into” the insurance space, not because he wanted to be a traditional broker, but because he was searching for a real solution to the U.S. healthcare crisis. Americans spend nearly 20% of GDP on healthcare—roughly double other developed countries—yet the U.S. ranks poorly on outcomes. To Mark, this is a sign of deeply flawed incentives in how healthcare is purchased and delivered.

CBG’s ideal clients are CFOs, CEOs, and HR directors who recognize that their healthcare spend is unsustainable and unpredictable, and who are frustrated by carriers refusing to share meaningful claims data. These leaders want to treat benefits as a strategic asset, not a nuisance to rubber-stamp during renewal season. By contrast, employers who simply “hit renew” every year and view healthcare as a speed bump are not a good fit for CBG’s transformative approach.

The engagement begins with a “Can we help you?” analysis in which CBG reviews the employer’s current plan at a high level, compares its trajectory to industry trends and to CBG-built plan performance, and quantifies potential savings. If the projected savings are only “budget dust,” Mark is comfortable saying the status quo might be fine. If the savings are compelling, they move to a build phase, where, for a small consulting fee, CBG designs a fully custom health plan rather than just shopping the census to carriers. This design process accounts for where employees live, what providers and hospitals are available, the client’s goals, and appetite for change.

What sets CBG apart is its guaranteed results. Mark’s team models specific savings metrics and then guarantees them. If they miss the mark, the consulting fee is refunded. If they hit the mark and the employer implements the plan, the fee is still refunded, because CBG shifts to a per-employee-per-month fee to administer the plan. Unlike traditional brokers, CBG does not earn commissions based on premium volume—and therefore doesn’t get paid more when costs go up.

This is a 180-degree departure from the prevailing model, where carriers and brokers often earn more when healthcare gets more expensive, creating incentives for the system to become larger and less efficient. Mark argues that many of the intermediaries embedded in standard health plans are adding cost without commensurate value. CBG’s approach is to remove those layers, build direct relationships with high-quality providers, and stack in targeted solutions where needed.

One of the biggest obstacles to change is data access. Mark calls out the common carrier line that HIPAA prevents sharing claims details as a “load of crap,” noting that employers have a fiduciary duty to oversee plan spending, much as they do with retirement plans. Without data, you can’t identify cost drivers, shop alternatives, or negotiate effectively.

But data alone isn’t enough. Many employers receive wellness reports and utilization dashboards yet fail to actually do anything with them. CBG instead uses data as a tactical map. If emergency room usage is out of control, they implement a solution that can, for example, cut ER costs by 80% while steering employees to smarter options with $0 out-of-pocket costs. If specialty drugs or cancer care are major spend categories, CBG sources dedicated programs and contracts that reduce both frequency and severity of those claims.

Throughout the episode, Mark emphasizes aligned incentives. In CBG’s plan designs, employees retain freedom to choose any provider, but traditional deductibles and copays apply if they ignore the plan’s guidance. If they follow recommended, cost-effective options, they often pay nothing. This “carrot and stick” approach nudges better choices without heavy-handed restrictions.

Dan and Mark also discuss CBG’s client profile and growth journey. While the model can work for employers with as few as 30 employees, CBG now focuses on groups with 100+ lives because larger plans open up more solution options and negotiating leverage with hospitals and other providers. CBG continues to serve some legacy mid-sized clients, many of whom have seen substantial savings with custom self-funded structures.

On the business development side, CBG finds new clients through direct marketing and referrals. Some of their referral sources are delightfully unconventional—a traveling nurse, a preacher with a large network, and attorneys who understand the healthcare system’s legal and political dynamics. One of the most interesting segments Mark talks about is hospitals themselves. By fixing a hospital’s internal benefits plan and then helping local employers design plans that steer care there, CBG can simultaneously drive revenue to the hospital and lower costs for the community, especially in rural areas where hospitals are under intense financial pressure.

Looking ahead, Mark thinks the next 5–10 years will bring more transparency and more tools, but not a single-payer overhaul. The winners will be organizations that use data to systematically attack the biggest cost drivers—especially high-cost chronic conditions and specialty treatments—while maintaining or improving quality of care. For CBG, staying ahead means being in the trenches every day, solving new problems as they appear, and constantly pivoting to better options.

In the more personal portion of the conversation, Mark shares that one of his biggest challenges has been being perceived as “too innovative”. Early on, employers were hesitant to be first movers with a model so different from traditional carrier relationships. Over time, as CBG accumulated years of documented savings and better outcomes, and as they introduced their guarantee, that skepticism softened.

During the lightning round, Mark reveals a lot about his mindset and habits. He drinks coffee, prefers dogs, and names AI as the most important tool in his work life aside from his phone and computer. He’s a heavy ChatGPT user and warns that anyone still working who isn’t leveraging AI risks falling behind or being automated out of a job. CBG uses AI internally to analyze incoming support tickets, summarize issues, and suggest draft responses, which humans then refine before sending.

On the reading front, Mark recently enjoyed Extreme Ownership and is in the middle of The Dichotomy of Leadership, both by Jocko Willink and Leif Babin. He also references the 80/20 principle as a key framework that changed how he thinks about productivity. More broadly, he credits much of his progress to mentors—both in person and via books—and says his biggest advice to his younger self would be to seek mentorship earlier and more intentionally.

He shares a fun bucket-list story about wanting to be invited onto a stranger’s yacht. While at a waterfront restaurant with his wife, he met professional tennis players who happened to be on a large yacht and invited them aboard. After some initial hesitation from his wife, they went, spent hours enjoying the impromptu experience, and Mark got to check off that unusual bucket-list item.

As for future goals, Mark wants to eventually build a second company in a different industry, but he’s committed to staying focused on CBG until it can operate roughly 90–95% autonomously—a milestone he expects could take another 3–5 years.

The episode ends with Dan thanking Mark for his candid insights, his willingness to challenge the status quo in healthcare, and his clarity about aligning incentives, leveraging AI, and building around mentors. For any employer leaders tuned in, the core message is clear: you don’t have to accept opaque, ever-rising health plan costs. With the right partner and a willingness to rethink the model, you can design a plan that delivers better outcomes for both your P&L and your people.

Full Transcript

Announcer: Brought to you by Tailored Wealth, helping business leaders live their version of a rich life.

Announcer: Welcome to another edition of the Making Sense of Your Money podcast, where we cut through the financial noise and help business leaders to make smart, confident money decisions.

Dan: Hello and welcome again to the Making Sense of Your Money podcast, where we help you take control of your finances, minimize uncertainty, and maximize your wealth potential.

Dan: I’m your host, Dan Pasone. I am the founder and CEO of Tailored Wealth. And today, I am excited to introduce and bring on a special guest. We’ve got with us Mark Fox, who is the owner and president of CBG. Mark is in the healthcare space and him and his firm are doing some really nice and innovative things there.

Dan: So Mark, thanks for joining the Making Sense of Your Money podcast and we’re psyched to have you today.

Mark: I’m glad to be here. Thanks for having me.

Dan: You bet, man. You bet. We’re going to have some fun. We’ve got a lot to cover and I know that our audience would love to kind of get your expert take on some key topics. So let’s jump right in.

Dan: First and foremost, give us a quick 90-second overview of what your business does and then tell us a little bit about how you got into it as well.

Mark: Yeah, sure. Well, I’ll start with how I got into it. I’m going to flip it on you only because most people get into the insurance space by accident. It’s typically not on purpose. I think there’s only one university that offers a master’s degree in our space in the entire country. So it’s a little bit unique.

Mark: It was by mistake. I really was searching for a solution for Americans when it comes to healthcare. And that’s kind of what led us to what we do today. So I’ll get into that.

Mark: We build custom plans for employers. That’s the simplest way of putting it. We’re bringing together the provider—the doctor, the hospital—and the patient. And we’re getting rid of all the middle people. There are a lot of them. And so by doing so, we’re increasing the quality of care and reducing the cost significantly.

Mark: And it starts at the employer level. So we’re really excited about how we’re making change in America. We’re literally seeing the landscape of healthcare change dramatically. I’ll talk a little bit about that later on, but it’s really exciting to see how we’re making an impact not just from the employer level, but also to the individual pockets of the employees. Super excited.

Dan: Awesome, man. Awesome. That’s a great story and I’m excited to learn more about that. Tell us, if you don’t mind, tell us a little bit about your ideal client and then what you ultimately help them to do in the healthcare space.

Mark: Yeah. So our ideal client is the CFO, CEO, HR director who realizes that their current spend in healthcare is unsustainable. It’s also unpredictable. And they’re tired of the big insurance companies hiding their data. Those individuals recognize that change is needed and that they need to provide a better service to their employees.

Mark: They recognize that their employees rely on them to make good business decisions. And so we’re looking to partner with those types of individuals. There are types of individuals out there that see healthcare as a speed bump. They just hit that renew button every single year. They’re not really looking for change, in which case we’re not really a good fit. So we’re looking for those who are looking for change and want better results.

Dan: And once they find you—you know, the CFO, the HR director that is looking for that change with respect to their healthcare offerings—what do you ultimately help them to do? What do you typically find as the end result once they engage with you?

Mark: Yeah. So we walk them through the initial stages. We start with: can we help you, right? And we look at your plan from a macroscopic level and receive a little bit of high-level data and then find out where is your plan headed over the next 5 years. We compare that to where the industry is and also the results of what CBG can do. And so we can see exactly where that gulf is. Does that savings metric make sense for change or is it budget dust?

Mark: So we do that for free initially. Then if that savings number looks very attractive and looks warranted for change, then we go into the build phase in which case our clients sign a letter of engagement. We charge a very small fee to build a custom health plan from the ground up. This is not taking the census and just shopping it with all the insurance companies out there. There are a ton of brokers who can do that for you. You do not need us to handle that.

Mark: We are building it from scratch. It is very customized and it’s specific to your organization—where your employees are located, your goals, etc. And once we build that plan, we also guarantee the results. So if we don’t hit our savings metrics, we refund our initial consulting fee.

Mark: If we do hit our savings metrics, but you decide to implement the plan that we build, we still refund you our fee because we charge a flat per-employee-per-month fee to manage the plan that we build for you. And we guarantee those savings metrics results. There is nobody in this industry that has a guarantee. Not that I’ve seen anyway. They don’t use the word certainty or guarantee or predictability. They can’t. They always use the words “well it depends.”

Mark: So we start with that: can we help you? We walk through the build phase and then comes time for the big decision of: do we implement this plan? So that’s kind of the process we take.

Dan: Yeah. And so my next question was going to be what makes you unique, but I think you kind of hit on that, Mark. I haven’t heard of others that are going to this sort of level of depth to customize a plan and/or give any form of guarantee.

Dan: How are you able to do this and kind of what made that fit for you and made that right for you and your business and ultimately what you help your customers accomplish?

Mark: Yeah, I’ll start with why, because if we don’t do something, who will? The world of healthcare is getting worse. We spend 20% GDP almost on healthcare and it’s getting worse.

Dan: Yeah.

Mark: You know, just talking about the kind of the problem for a second. I mean you’ve got the United States spending twice as much as other first-world countries. The World Health Organization has us ranked at number 37 on quality. Costa Rica has us beat at number 36. So we’re not getting what we’re paying for. That’s kind of the why behind why we’re trying to help employers out there.

Mark: But going through that process… I apologize, what was the first part of your question there? I want to make sure I answer that.

Dan: Yeah. Tell us a little bit about how you’re able to do this level of customization for your clients that maybe the others that are in your space aren’t doing.

Mark: Yeah, that’s a good question. Okay, so the reason why we’re able to is because the bar is really, really low. And our business model is 180 degrees different. You have large broker firms out there, insurance firms who work off of commission, and they actually get a bigger paycheck for doing a bad job.

Mark: What do I mean by that? They get paid more when they deliver a renewal with an increase. I don’t find that to be an aligned incentive and I don’t think most employers would either. But yet, we hit the renew button every single year and just accept it.

Mark: So since we don’t work off of commission, we’re able to guarantee the results because we’re getting rid of the middles that are fluffing this thing and making it expensive. That’s why employers are getting these 20% renewals, 30% renewals, because everybody in the middle of the plan gets paid more for doing a bad job. Think about, you know, the surgeon who leaves a tool inside of the knee—they get paid again for going in and getting that tool. Absurd.

Mark: So with our plan design, and since we’re not trying to keep shareholders happy, we’re able to get rid of those middles and realign the incentives. That is the number one thing with every health plan: you have to have aligned incentives. And as a consultant, we sit on the same side of the table as the employer. So when they win, we win. That’s better.

Dan: Makes a lot of sense. Makes a lot of sense. I’m a big fan of that approach to aligning the incentives. I think that that’s always a good business model.

Dan: Mark, tell us a little bit about the top challenges that your clients face when you start a new engagement and then maybe a little bit about how you help them to overcome those challenges.

Mark: Yeah. So the top challenge is going to be data. The big insurance companies are just hiding everything. They don’t want you to know what you’re spending and what you’re spending it on. And they hide behind HIPAA. They say, “Oh, you know, HIPAA, we can’t give that to you.” Sorry, that’s a load of crap. Sorry, I’m not sure if I’m allowed to say that on here, but it is.

Dan: You are, you are.

Mark: Because employers have a fiduciary responsibility to make sure plan assets are spent prudently. Just like on the financial side, right? You have a set of rules that determine whether or not this is a good decision or not for the employees and as the plan as a whole.

Mark: So to say, “Oh, well, HIPAA prevents us from sharing what you’re spending your money on,” is just a giant screen. And they’ve been winning that game for decades. And that’s the reason why premiums keep going up. If you actually knew what you spent your money on, then you’d be able to do something about it. You’d be able to shop it. You’d be able to find a better supplier—more efficient, lower cost.

Mark: So that’s the number one hurdle: the lack of transparency and data. And then the next hurdle, the second most important, would be: okay, once we fight and we get our data, what the heck do we do with it, right? How do we actually act on this?

Mark: I see wellness companies all the time providing these services and getting data for these employers, and they’re like “Great, now we know exactly where our money is being spent,” and they do nothing with it. They sit along the sidelines.

Mark: And so what we do is we bring in high-quality providers and solutions into the plan to utilize that data and we attack based on where your plan spend is. We had an employer—I’ll give you an example—who was spending a lot on emergency room cases. Emergency is one of the hardest types of claims to mitigate because you never know when it’s going to happen and you can’t pre-negotiate it with, you know, a random ER center. Whereas a planned surgery is much easier. You can pre-negotiate that because you know when it’s going to happen and what needs to happen.

Mark: So we were able to put in a solution that reduced their cost by 80% on emergency room claims. And the employees paid nothing, by the way, during those emergency claim visits.

Mark: We do use kind of a stick-and-carrot approach where the employee still has all the choices that they’re used to having, but standard deductibles and copays apply. If they’re smarter about how they’re consuming healthcare, they pay zero.

Dan: Okay. Okay. Makes a lot of sense. Makes a lot of sense.

Dan: Mark, how do your clients typically find you?

Mark: Yeah. So it’s pretty difficult actually because there’s such a big blue ocean out there and you have Cigna, Aetna, Blue Cross Blue Shield, and United controlling the market. So a lot of times they either hear about us through one of our marketing outreaches, like an ad or something like that, or they’ll find out from one of our current clients. That’s typically how we get in contact with new employer groups.

Mark: And then we sit down. We just have a conversation with them much like this, just kind of figuring out, okay, where are you? Where have you come from? Where are you trying to go? What are your goals? Is it possible that we could be a good fit—vice versa?

Mark: So we look at working with employers that have 100 employees or more. What we do today we used to do for smaller employers. This strategy works for employers that have as low as 30 employees. We actually still have some legacy accounts that have between 30 to 50 employees and are saving a lot of money through this custom strategy.

Mark: For CBG though, for us to go upmarket was wise. We had more solutions to be able to offer and it also allowed us greater negotiation ability with the different providers, hospital systems, things like that when we were bringing more lives to the table.

Dan: Makes sense. Makes sense.

Dan: One of the things that we try to identify here—we’ve got a lot of different professionals that tune into this podcast in different spheres of financial services and business. Do you collaborate with referral partners at all? And if you were them, why would they consider a referral partnership with you?

Mark: We do. Yeah. So we have to spend money on marketing some way, right? And time. So we do work with referral partners. Some of them are very unique. We have a traveling nurse that refers organizations to us. We have an evangelist, a preacher who knows a lot of people who has referred business to us. We also have individuals in the legal sector who understand kind of the workings and the politics of the healthcare industry who have referred business.

Mark: And you know what’s strange is some of the best prospects are actually hospitals because they don’t understand how huge of an impact they can have on their community. So we fix the plan for the hospital and then we go local, right? We localize healthcare in that area.

Mark: We have an epidemic in America right now with hospitals in rural areas closing down left and right because they can’t compete with the nonprofit hospital that’s 2 to 3 hours away. With our plan, they can, and it succeeds substantially and drives revenue while also saving their local community a ton of money. So they just don’t know how to have that conversation or how to organize that. And that’s where we come in.

Dan: Makes a lot of sense. That’s a nice segue.

Dan: Tell me, where do you see your industry going in the next 5 to 10 years? And how do you plan on staying on top of that?

Mark: Yeah. So this industry changes every day, especially depending on who’s elected. You know, there’s been a lot of talk about single-payer, which will never happen. It’s a nice term people talk about and it’s a hot topic, but for a lot of political reasons, which I won’t get into, it’ll just never happen.

Mark: So I really think that… you know, Dan, I apologize, I’m just having a little bit of a brain fog here. Can you repeat your question so I can make sure I get it? I had a thought, I lost it.

Dan: All good. Where do you see the industry going in the next 5 to 10 years? And tell me how you plan on staying on top of it.

Mark: Yeah. So the industry is changing significantly, but for the better. I think we’re seeing more transparency. So for CBG to stay on top of that is just making sure that we’re in the trenches every single day. We’re looking at ways to solve problems.

Mark: This is a pivoting-type business, meaning that if we come across a new issue, we find a solution for it—and there always is one, we just have to find it. So this industry does change significantly. We’ve seen a lot more transparency. The problem is employers just didn’t know how to use that data that they can get now that they couldn’t get 3 years ago.

Mark: So politically, I think things are pretty interesting depending on who’s in office. But I think staying on top means asking: where do we spend our money and how do we address it? So if it’s cancer, what kind of cancer solution can we put in? If it’s specialty medications, what kind of specialty medication solution can we put into our plan to help mitigate that cost?

Mark: Those are the questions to ask. How do we mitigate the frequency and severity of our claims? If we can solve for that question, we’ll solve for healthcare in America.

Dan: That’s a really powerful statement. Very well said.

Dan: All right, let’s transition a little bit. We’re going to start to talk about you. I’ve got one question before we get into our lightning round.

Dan: What’s the biggest challenge, Mark, that you’ve faced to this point in your life and how has that helped you shape the way that you do business?

Mark: Yeah. So the biggest challenge in my life, I think, is probably just being seen as too outside the box, right? Too innovative, and “it’s never been done, so it can’t be done.” And so kicking against the pricks on that has been challenging.

Mark: And so when it comes to business, you know, early on in our company, it was a struggle because no employer wanted to be the first one. They did not want to be the guinea pig. So we had to have results. And once we got a few years under our belt and we showed significant savings, results, and better benefits and higher quality care—employees back at work, more productive, more loyal—we were able to take that story and run with it.

Mark: And so we’ve seen a lot more employers now taking advantage of it. But it was an initial hurdle, that initial “who’s going to be the first one,” right, of getting over the different changes and the different challenges that they were seeing inside of their health plan. And “Who is this CBG?” right? “They’re doing things different. I don’t know about that. If it’s that good, everybody would be doing it,” right? We got that several times. But we’ve been able to overcome that now since we’ve gotten the results. And that’s why we guarantee the results, right? Because it shows employers that, hey, this is a no-duh business proposition.

Dan: Yeah. Albeit a very different business, we’ve used a similar business model where we really try to de-risk the initial engagement so that folks see the results without having to take on a ton of risk. And then, to your point, from there once they see the results, it’s just a compounding and a snowball effect.

Dan: So I’m definitely on board with you there, and kudos to you and your team for innovating, because I think it’s the right way to offer any sort of business service in this day and age.

Dan: All right. So now we are at the lightning round, Mark. So we’re going to have some fun with this. This is pretty simple. You’re just going to give the first answer that comes to mind and we’re going to get to know you a little bit better.

Mark: Sounds good.

Dan: All right. Coffee or tea?

Mark: Coffee.

Dan: Cats or dogs?

Mark: Dogs.

Dan: Okay. What’s one tool or technology other than your computer or your phone that you can’t live without?

Mark: AI.

Dan: Okay. All right. Me too.

Dan: Favorite quote or phrase about money, business, or success?

Mark: That’s a tough one. There are so many out there. Yeah, I really don’t know because there are so many different items that we could pick. I might have to take a pass on that, but I’ll say this: I’ve had a lot of mentors in my life and that is the only reason why we know how to do what we do today, is because we’ve put the right mentors in to be able to teach us various avenues of business. So I think making sure that you have the right mentor is super important—whether that’s in book form, like the stack of books I have behind me, or it’s physically face to face.

Dan: All right. Well that’s a great segue to my next one. Favorite book on business or success?

Mark: Man, that’s also a really hard question. There are so many. I’ll just go with the most recent one that I read, which is Extreme Ownership.

Dan: Yep. Jocko.

Mark: And I’m right in the middle of the sequel right now, The Dichotomy of Leadership.

Dan: Dichotomy of Leadership is on my list, actually. So I’m glad you mentioned that. I read Extreme Ownership many years ago. Actually saw him speak a couple times as well. So those are good ones for sure. Those are good ones.

Dan: Any personal productivity hacks you can share?

Mark: You know, I actually really struggled years ago on being organized and staying on top of being productive. And then I read this book called the 80/20 rule, right? Which is another great book to bring up. And I also had another coach who helped me understand that you have to identify your greatest weaknesses and work on those. And my biggest, greatest weakness was being organized.

Mark: So I would say the greatest hack right now is AI because it is so powerful and it can help you stay so organized and automate repetitive tasks that you just don’t need to be doing. So I find myself using AI multiple times a day—not just with tasks, but also with teaching me new things.

Mark: I would say if you’re not using AI, I sure hope you’re already retired, because if you’re still working right now and you’re not using it, you will be left behind or your job will get replaced. There’s a big statistic out there right now talking about how AI is replacing like a third of transactional jobs out there by the next five years. So I’m really scared for those types of individuals who aren’t dialing into it.

Dan: You a ChatGPT guy? What do you typically—what’s your go-to AI source today?

Mark: Yeah, usually ChatGPT, but there are a lot of them out there. A lot of different models—long models or short models. It depends on the task. I think you have to be very intentional on which model you’re using based on the result that you’re trying to get and what task you’re trying to get it to do. But yeah, usually ChatGPT is my go-to.

Mark: Our organization has AI used significantly to help service our clients. You know, for example, we have a couple different departments, but one of them is our support team. It will analyze when a support ticket comes in and give a synopsis of that ticket to our agent and make a recommendation on a potential reply. And then we— you know, we don’t typically take that reply, but we take its recommendations and then we mold it specifically to what we needed to say.

Mark: And it’s helped significantly, because if we’re reducing the amount of time on repetitive tasks, then we can be on the phone more with clients and having real conversations with them and walking them through anything that they’re working on or they need.

Dan: Very cool. Love that. Love that.

Dan: What’s one bucket list item you’ve already accomplished?

Mark: Okay, I’ve got a fun one for you. So I love bucket list items. So one of my bucket list items was to get invited onto a yacht by a stranger and just have a good time, you know.

Mark: So me and my wife were at a restaurant, and we actually didn’t have our son with us, which is a rare occasion. And it was a waterfront restaurant. We got to know these individuals who were professional tennis players, and they pulled this very large yacht up to the restaurant and they invited us to go with them. And so I’m more of the extrovert in the relationship. And so I had to kind of sell my wife on, “Hey, this is a bucket list item for me. We really gotta do this.”

Mark: So she was like, “Where are they going to go? What if they drop us off somewhere randomly?” I’m like, “We’ll figure it out. This is like Amazing Race. We’re good. We’ll find a way back home,” you know? And we got to know them really well. We did get on the yacht. They didn’t actually end up going anywhere. We just had a good time right there on the yacht for several hours and had a fun time. So that was a bucket list item that was accomplished and checked off, I think about two years ago now.

Dan: Wow. That’s very cool. That’s a different one. I’ve asked this question a bunch and I haven’t heard that before—get invited on a yacht by a stranger. Very cool.

Mark: “Honey, we gotta do this. It’s on my bucket list.”

Dan: I think I’m going to use that moving forward for a lot of different items.

Dan: What is one business or financial milestone that you’re still working towards?

Mark: Yeah. So business milestone would be to actually open up a second company that’s completely unrelated to this industry. That is still yet to be accomplished, because I felt like CBG needed more of my time right now before it can fly completely. And I would say when I say completely, I really mean like 90–95% on its own.

Mark: And so we’re still in that process and will be for, you know, at least the next 3 to 5 years. But there are two to three other companies that I think would have a big impact on America that are different and not in this industry.

Dan: Very cool. Very cool. I look forward to following that journey with you.

Dan: Last one. If you could give one piece of advice to your younger self, what would it be?

Mark: Get a mentor faster. Find out who the expert is in this field and be at their side 24/7 as much as you possibly can—whether you’re reading their books or their articles or physically getting together with them and paying for their mentorship. I wish I had done that.

Mark: I actually—side note—I owned my own agency in the traditional sense of insurance years ago. I sold that business and worked for a larger company. During that time, I learned a lot, but I had to learn it the hard way. And it took a long time to generate decent revenue. And had I just put myself—and humbled myself—and gotten a mentor and started learning that I don’t really know everything and gotten someone who knows a lot more than me to teach me some ropes in all aspects of business, not just in the healthcare industry, we would have been in this area of our lives and in our business much sooner. So that’s what I would have told my younger self.

Dan: Very cool. Very cool. Good advice. And I could not agree more with that one. And I definitely would have told myself that earlier on.

Dan: All right, Mark. Finally, if our listeners want to connect with you, collaborate, work with you, learn from you, what’s the best way to reach out to you?

Mark: Yeah, you can reach out through our website, cbghealthpl.com—that’s cbghealthpl.com. Or you can shoot me an email and I’ll route you to one of our team members or I’ll work with you directly. And my email address is mark@cbghealthpl.com. That’s mark@cbghealthpl.com.

Dan: Very cool. Very cool. We will put that in the show notes as well.

Dan: Mark, great stuff today. Really enjoyed it. Thanks for sharing your time. Thanks for sharing your insights, your wisdom, your experiences, getting a little vulnerable with us. We appreciate that. So thanks for being on the Making Sense of Your Money podcast.

Mark: Thanks so much.

Dan: All right, everybody. This is another episode of Making Sense of Your Money with Mark Fox. Cheers and have a great one.

Dan: Awesome, dude. That was fun.

Mark: Hey, sorry I lost my train of thought a few times there. I apologize about that. It’s honestly like—and again I’ll…

Resources & Citations

CBG (Custom Benefits Group): Mark’s firm that designs and manages custom, self-funded employer health plans.
U.S. healthcare spend & rankings: Public data from the World Health Organization and OECD highlighting U.S. healthcare spending (~20% of GDP) and comparative outcomes.
Self-funded employer plans: Resources explaining how self-insurance, stop-loss coverage, and reference-based pricing work for mid-size and large employers.
Jocko Willink & Leif Babin – Extreme Ownership & The Dichotomy of Leadership: Leadership and accountability frameworks drawn from Navy SEAL experience.
80/20 (Pareto) Principle: Books and resources on focusing efforts on the 20% of activities that drive 80% of outcomes.
AI in business operations: General resources on using tools like ChatGPT to automate tasks, streamline support, and enhance decision-making.

FAQs

What kind of employer is a good fit for CBG’s approach?

Generally, employers with 100+ employees who:

Are frustrated by double-digit health plan renewals
Want data transparency and insight into claim spend
Are open to a custom, self-funded model instead of off-the-shelf fully insured plans
Care about employee experience and not just shifting costs onto staff

The underlying strategy can work for groups as small as ~30 employees but has the most flexibility and leverage for larger groups.

How is CBG compensated if they’re not taking carrier commissions?

CBG charges:

A small consulting fee for the plan design/build phase
A per-employee-per-month (PEPM) fee to administer the plan if implemented

If projected savings aren’t realized, the consulting fee is refunded. If they are realized and the plan is implemented, the fee is also refunded, and CBG is paid via the ongoing PEPM. This structure is designed to align incentives with employers rather than with premium volume.

What does it mean to “remove middlemen” in a health plan?

Most traditional plans involve multiple intermediaries—carriers, PBMs, networks, TPAs—each taking a piece of the healthcare dollar. Many are compensated in ways that reward higher costs or utilization. CBG’s custom plans look for ways to:

Work more directly with providers and health systems
Use transparent TPAs and other vendors whose pay is not tied to claims inflation
Simplify the chain between employer, provider, and patient

Removing or restructuring these layers can significantly reduce cost while improving clarity.

Is this just another “broker shopping the market” service?

No. Mark is explicit that CBG does not simply take the employer’s census and get quotes from carriers. Instead, they:

Analyze existing spend and utilization
Design a custom self-funded or level-funded structure
Source specific solutions for high-cost areas (e.g., cancer, specialty meds, imaging, ER)
Negotiate directly with providers and support partners as needed

The result is a plan tailored to the employer’s footprint, workforce, and goals—not a boilerplate carrier product.

How does the “carrot and stick” model affect employees?

Employees typically:

Retain full access to any provider they want, with standard deductibles and copays
Have the option to use curated, high-value providers and services where they often pay $0 out of pocket

The idea is to nudge behavior toward more efficient, higher-quality care by making the right choices cheaper and simpler, without removing choice entirely.

What kinds of cost reductions are realistic?

Results vary by employer and starting point, but in Mark’s example, ER-related costs were reduced by around 80% for one client. Other categories—like imaging, elective surgeries, specialty drugs—can also yield substantial savings when targeted with the right solutions. CBG models expected savings and guarantees those metrics for each engagement.

How does AI actually show up in CBG’s operations?

Within CBG, AI is used to:

Summarize support tickets and surface key facts for agents
Suggest draft responses that humans then refine
Help with research, organization, and learning around new solutions and regulations

This reduces time spent on repetitive tasks and allows more human time for client strategy and complex problem-solving.

Disclaimer

This episode and written summary are for educational and informational purposes only and do not constitute legal, tax, financial, medical, or insurance advice. They do not create any client or advisory relationship with Tailored Wealth, CBG, or any other entities mentioned.

Health plan design, self-funding, and benefit strategies involve significant legal, financial, and operational considerations. Before making changes to your organization’s health plan or implementing any strategy discussed in this episode, you should consult with qualified professionals, including:

A licensed health insurance professional or benefits consultant
Legal counsel familiar with ERISA, HIPAA, and healthcare regulations
Your company’s financial and tax advisors
Any relevant third-party administrators, carriers, or HR systems vendors

Past results and examples mentioned by Mark or Dan are for illustration only and do not guarantee future outcomes. Every employer’s situation is unique.

Next Steps

If you’re an employer leader concerned about healthcare costs, consider:

Quantifying your trajectory: Ask your broker or carrier for multi-year claims and cost data. If they refuse, push harder or consider a new partner.
Assessing alignment: Evaluate whether your current broker’s compensation aligns with your goals—or whether they’re rewarded when your costs go up.
Mapping cost drivers: Identify the top 3–5 categories of spend (e.g., ER, inpatient, specialty meds, imaging) and brainstorm possible solutions for each.
Exploring custom plan options: Speak with firms like CBG that specialize in self-funded, custom-plan design and are willing to model and guarantee savings.
Integrating into your financial plan: Work with your financial advisor (such as Tailored Wealth) to incorporate healthcare strategy into your broader 5–10 year financial projections.

To keep upgrading your decision-making around benefits, cash flow, and long-term wealth, check out more episodes of Making Sense of Your Money or connect with Tailored Wealth to build a coordinated plan for your business and personal finances.