--- title: "Revolutionizing Employee Healthcare | Dan Pascone with Mark Fox | Podcast # 03" description: "Employer healthcare costs are exploding because the system pays middlemen more when costs go up. Dan and healthcare innovator Mark Fox of CBG break down how self-funded health plans can remove misaligned intermediaries, lower costs, and give employers real transparency into their claims data." url: "https://yourtailoredwealth.com/podcasts/mark-fox" lang: "en" published: "2025-02-21T00:00:00+00:00" modified: "2026-10-12T13:36:40+00:00" author: "Dan Pascone" --- # Revolutionizing Employee Healthcare | Dan Pascone with Mark Fox | Ep #03 _Interactive content (form or widget). Open https://yourtailoredwealth.com/podcasts/mark-fox in a browser to use it._ ## TL;DR Employer health plan costs are hard to manage when you can't see where the money goes. In this episode, Dan talks with Mark Fox, owner and president of CBG, about how his firm builds custom health plans for employers, why he believes the way many brokers are paid works against the employer, and why access to claims data is the first hurdle. Mark's view is that aligned incentives and real transparency are what let an employer act on its spending. For executives and business owners in their 40s–50s, the takeaway is practical. Your company's health plan is a large, recurring cost, and the same rising-cost problem shows up in your own retirement plan when you think about coverage before Medicare. Two questions are worth asking: how is everyone on the plan paid, and what does the claims data actually show? This is general education, and the results Mark describes are his own. ## Who Is Mark Fox? Mark Fox is the owner and president of CBG, a firm in the healthcare space that builds custom health plans for employers. He says most people get into the insurance space by accident, and he did too. By his account, only 1 university in the country offers a master's degree in the field. What pulled him in was a search for a better solution for Americans when it comes to healthcare, and that led to what CBG does today. In his words, CBG brings together the provider, the doctor, the hospital and the patient, and gets rid of the middle people. He says that approach increases the quality of care and reduces cost, and that it starts at the employer level. Before CBG, he says, he owned his own insurance agency, sold it and worked for a larger company. ## Who CBG Works With Mark describes the ideal client as a CFO, CEO or HR director who realizes the company's current healthcare spend is unsustainable and unpredictable, and who is tired of the big insurance companies hiding their data. These are leaders who see that employees rely on them to make good business decisions. He says CBG is not a good fit for employers who treat healthcare as a speed bump and hit the renew button every year. CBG works with employers that have 100 employees or more. Mark says the strategy can work for groups as small as 30 employees, and CBG still has some legacy accounts with 30 to 50 employees. Going up market was wise for CBG, he says, because it gave the firm more solutions to offer and more negotiating leverage with providers and hospital systems. ## How the Engagement Works Mark describes a process with 3 stages: * **Free first look:** CBG reviews the plan at a high level, projects where it is headed over the next 5 years, and compares that with where the industry is and what CBG says it can do. The goal is to see whether the potential savings justify change or amount to what he calls budget dust. * **Build phase:** If the savings look worthwhile, the client signs a letter of engagement and pays a small fee for CBG to build a custom plan from the ground up. Mark says this is not taking the census and shopping it to every insurance company, which he notes many brokers can do. The plan is specific to the organization, where its employees are located and its goals. * **Implementation decision:** The employer then decides whether to implement the plan. Mark says CBG charges a flat per employee per month fee to manage the plan it builds. Mark says CBG guarantees its savings metrics and refunds the initial consulting fee if it doesn't hit them. He adds that if the employer implements the plan, the initial fee is refunded and CBG is paid through the ongoing monthly fee. \[VERIFY: this is the guest's description of his own firm's terms. Tailored Wealth has not reviewed those terms, and we don't evaluate or endorse CBG's services.\] ## Why Incentives Matter Mark says CBG can do this because the bar is low and its business model is a 180 degree difference. He says large broker and insurance firms often work off commission and get paid more when they deliver a renewal with an increase. He doesn't think that is an aligned incentive, and he points to the 20% and 30% renewals many employers accept every year. CBG doesn't work off commission, he says, and sits on the same side of the table as the employer, so when the employer wins, CBG wins. \[VERIFY: these are Mark's characterizations of the industry, not Tailored Wealth's, and compensation varies by broker and plan.\] He also sets the stakes. He says the United States spends almost 20% of GDP on healthcare, about twice as much as other first-world countries, and he cites a World Health Organization ranking that put the U.S. at 37 on quality, 1 spot behind Costa Rica at 36. \[VERIFY: figures are Mark's from the 2025 recording. Confirm the source and year of the WHO ranking before publishing.\] For current employer cost data, KFF publishes its annual [Employer Health Benefits Survey](https://www.kff.org/health-costs/2025-employer-health-benefits-survey/). ## The Data Problem and What to Do About It Mark says the top challenge is data. In his words, the big insurance companies hide what employers are spending and what they're spending it on, and often point to HIPAA as the reason. He disagrees. His argument is that employers have a fiduciary responsibility to make sure plan assets are spent prudently, and that you can't do anything about costs you can't see. \[VERIFY: an employer's fiduciary duties and what claims data it can access depend on the plan type and applicable law. Confirm with benefits counsel.\] The second hurdle is what to do once you have the data. Mark says he sees wellness companies hand employers data and then sit on the sidelines. CBG instead brings high-quality providers and solutions into the plan and goes after the areas where spend is concentrated. His example was an employer with a lot of emergency room spend. He says emergency claims are among the hardest to mitigate because you never know when one will happen and you can't pre-negotiate with a random ER, while a planned surgery is much easier to negotiate. CBG put in a solution that he says reduced that employer's emergency room costs by 80%, and the employees paid nothing during those visits. \[VERIFY: this is 1 client example from the guest. Results vary by employer.\] Employees keep the choices they're used to having, with standard deductibles and co-pays. Mark calls it a stick and carrot approach: if employees are smarter about how they use healthcare, they pay zero. ## How Clients Find Him and Who Refers Mark says it's difficult to get found because a few big insurance companies control the market. Clients usually hear about CBG through its marketing outreach or from a current client. Then they sit down for a conversation about where the employer is, where it's trying to go and whether it could be a good fit, in both directions. CBG works with referral partners, and some are unusual: a traveling nurse, a preacher who knows a lot of people, and people in the legal sector who understand the workings and politics of healthcare. He also says some of the best prospects are hospitals. Mark says many don't realize how much impact they could have on their community, and that rural hospitals are closing because they can't compete with a nonprofit hospital 2 to 3 hours away. His view is that fixing the hospital's own plan and then keeping care local can help it compete and keep dollars in the community. ## Where He Sees the Industry Going Mark says the industry changes every day. He sees more transparency than there was 3 years ago, but says employers often don't know how to use the data they can now get. To stay on top of it, CBG stays in the trenches and finds a solution when a new issue shows up. The questions he thinks employers should ask are where the money is going and how to address it: if it's cancer, what cancer solution fits, and if it's specialty medications, what solution helps mitigate that cost. In his words, if you can solve for the frequency and severity of claims, you "solve for healthcare in America." ## His Biggest Challenge Asked about the biggest challenge in his life, Mark says it has been being seen as too outside the box and too innovative, and hearing that if something has never been done, it can't be done. Early on, no employer wanted to be the first. CBG needed results, and after a few years of showing savings, better benefits, higher-quality care and employees who were more productive and more loyal, he says more employers came on board. He says that is also why the firm guarantees results: it makes the decision easier. Dan noted that Tailored Wealth has taken a similar approach to lowering the risk of an initial engagement. ## Lightning Round Highlights * **Coffee or tea:** Coffee. * **Cats or dogs:** Dogs. * **Tool he can't live without:** AI. * **Favorite quote:** He passed on picking 1, but said the right mentors are the reason CBG knows how to do what it does, whether in book form or face to face. * **Favorite business book:** _Extreme Ownership_. He's in the middle of the sequel, _The Dichotomy of Leadership_. * **Productivity hack:** AI. Mark says he struggled with organization until he read a book on the 80/20 rule and worked with a coach who had him identify his greatest weakness and work on it. He now uses AI multiple times a day, mostly ChatGPT, to stay organized, automate repetitive tasks and learn new things, and he picks the model based on the task. At CBG, he says AI summarizes support tickets and recommends a reply, which the team then shapes, so they can spend more time on the phone with clients. Our blog [Smarter Prompts, Smarter Money: How ChatGPT and AI Can Assist Your Finances](https://yourtailoredwealth.com/2025/03/21/smarter-prompts-smarter-money-how-chatgpt-and-ai-can-assist-your-finances/) covers how we think about AI and money. * **Bucket list item accomplished:** Getting invited onto a yacht by a stranger. Mark and his wife met professional tennis players at a waterfront restaurant, and they spent several hours on the yacht, which stayed docked, about 2 years before the recording. * **Milestone still ahead:** Opening a second company completely unrelated to this industry, once CBG can run at 90–95% on its own, which he says is at least 3 to 5 years away. * **Advice to his younger self:** Get a mentor faster. He says he learned a lot the hard way and that humbling himself earlier would have gotten him where he is much sooner. ## What Most People Miss The first thing is incentives. Mark's core point is that you have to ask how every party in a plan is paid, and whether that pay rises when your costs rise. That question is worth asking about any advisor relationship, including ours. We're a fee-only fiduciary firm, so we're paid by our clients and not by commissions on products. The second is that data access comes before savings. You can't shop, renegotiate or redesign what you can't see. For a business owner or an executive on a benefits committee, a useful first step is asking for the plan's claims and utilization reports and its renewal history, and then asking a licensed benefits professional what they show. The third is on the personal side. Healthcare shows up in your own retirement plan, not just your company's. If your plan is HSA-eligible, an HSA can become a long-term, tax-advantaged account for medical costs. Our blog [How to Use Your HSA as a Tax-Free Retirement Account (2027)](https://yourtailoredwealth.com/blog/hsa-tax-free-retirement-strategy) walks through how we think about it. Eligibility and contribution limits change each year. \[VERIFY\] ## Example (Hypothetical): What Rising Renewals Could Add Up To This example is hypothetical, uses assumed figures and is not a prediction. Suppose a closely held company with 150 employees spends $15,000 per employee on its health plan, or $2,250,000 a year. Assume it then gets 20% renewal increases in 2 consecutive years, in the range Mark describes. * **Year 1:** $2,250,000. * **Year 2 (+20%):** $2,700,000, which is $450,000 more than Year 1. * **Year 3 (+20%):** $3,240,000, which is $990,000 more than Year 1. * **Added cost over Years 2 and 3:** $1,440,000 compared with holding Year 1 flat. On this plan, each 1% change is $22,500 a year. Actual costs, renewals and plan structures vary widely by employer. The planning question for an owner or executive is whether that growth is in the company budget and in your own plan, whether it affects when and how you step back from the business, and who is accountable for reviewing the claims data each year. That's a conversation for your benefits professional, CPA and advisor. ## How This Fits Our Approach at Tailored Wealth We use Life-Driven Planning, our 6-phase process (Cash Flow, Retirement & Hybrid Retirement, Risk, Expense & Goal, Tax and Legacy), to build a plan around how you want to live. A Hybrid Retirement is a phased approach where full-time work gives way to flexible, optional work rather than an abrupt stop. Healthcare costs touch several phases: Expense & Goal (what coverage costs before and after you step back), Risk (what's covered) and Tax (HSA and income planning). Our Life Driven Investing (LDI) approach builds the portfolio backward from your life, using the Four Liquidity Bands: money you'll need in 0–2 years, 3–5 years, 6–10 years and 10+ years. Near-term healthcare costs shape what belongs in the nearer bands. We revisit it all in our Quarterly Strategy Rhythm, a regular check-in each quarter where we review the plan against what has changed. We are a fee-only fiduciary firm. We don't design employer health plans, give insurance or benefits advice, or evaluate or recommend CBG or any specific plan or vendor. Plan design and selection are best handled by a licensed benefits professional, and we work alongside them and your CPA. For the retirement-plan side of employer benefits, see our video [The Ultimate Guide to Company Retirement Plans (Financial Advisor).](https://yourtailoredwealth.com/videos/company-retirement-plans-explained-the-smart-way-to-maximize-savings-with-dan-pascone/) ## Who This Is For This conversation is for executives and business owners in their 40s–50s with household income of $500,000 or more, especially those who own a company, sit on a benefits committee or have a say in how their employer's health plan is run. If healthcare is a growing line item in your company and in your own retirement picture, understanding who gets paid when costs rise, and what your data shows, is a good place to start. ## Frequently Asked Questions ### 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. ### How do I find out what my company's health plan really costs? Start by asking for the plan's claims and utilization reports, the renewal history for the past few years, and a clear list of how each vendor and advisor on the plan is paid. Mark says the lack of transparency is the top hurdle he sees, and that employers often can't act on what they can't see. What you can access depends on the plan type and the law, so ask a licensed benefits professional or employment counsel what applies to your company. This is general education, not benefits, legal or insurance advice. \[VERIFY\] ### Is a custom or self-funded health plan right for every employer? No, and it's not a decision to make from a podcast. In a self-funded plan, the employer pays claims directly instead of paying a fixed premium to an insurer, which can add cash flow variability, and employers commonly buy stop-loss coverage to limit that risk. Whether a plan like the ones Mark describes uses that structure is something to confirm with his firm directly. Company size, claims history, risk tolerance and workforce all matter. Talk to a licensed benefits professional before changing a plan, and ask any firm, including ours, how it's paid. \[VERIFY: Mark did not use the term self-funded in the recording, and the stop-loss description is general education.\] ### How does employer healthcare cost fit into an executive's retirement plan? It shows up in 2 places. At the company level, benefit costs affect cash flow and, for owners, may affect how the business is run and valued. At the personal level, your coverage before Medicare, your out-of-pocket costs and any HSA contributions belong in your retirement budget and tax plan. We build those into 1 plan using Life-Driven Planning. Our video [Don't Want To Retire, But Tired of Corporate? (Do This)](https://yourtailoredwealth.com/videos/hybrid-retirement-for-executives) shows how we think about a phased transition. If you'd like to talk through your own numbers, [book a Free Wealth Strategy Call](https://yourtailoredwealth.com/book-a-call) with Tailored Wealth. It's a low-pressure conversation about your situation. ## Talk Through Your Own Plan If you're thinking about how healthcare costs, your company and the timing of your income fit into your retirement, tax and equity picture, we're happy to talk it through. The Free Wealth Strategy Call is a low-pressure conversation about your situation. [Book a Free Wealth Strategy Call.](https://yourtailoredwealth.com/book-a-call) _Disclosure_ _The information provided is for educational and informational purposes only and does not constitute investment advice and it should not be relied on as such. It should not be considered a solicitation to buy or an offer to sell a security. It does not take into account any investor's particular investment objectives, strategies, tax status or investment horizon._ _No investment strategy or risk management technique can guarantee returns or eliminate risk in any market environment. All investments include a risk of loss that clients should be prepared to bear. The principal risks of Tailored Wealth’s strategies are disclosed in the publicly available Form ADV Part 2A._ _The views expressed in this commentary are subject to change based on market and other conditions. These documents may contain certain statements that may be deemed forward looking statements. Please note that any such statements are not guarantees of any future performance and actual results or developments may differ materially from those projected. Any projections, market outlooks, or estimates are based upon certain assumptions and should not be construed as indicative of actual events that will occur._ _Tailored Wealth and its advisors do not provide legal, accounting, or tax advice. Consult your attorney or tax professional. _