Every health system leader has unprecedented executive management challenges facing their organization in the wake of the pandemic. But when an organization focuses on the need, they develop solutions that offer excellent healthcare at an extraordinarily low cost. As leaders, taking care of our employees’ health is a priority, and finding the right provider can be challenging. It doesn’t have to be! Listen in as the President of ProvInsure, Ashley Bacot, talks about their innovative self-insured healthcare model that provides superior onsite primary care while reducing the employee and company’s healthcare costs. So don’t miss out on the chance to find out how you can provide your employees the care they deserve while saving millions of dollars.
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ProvInsure: Innovative Self-Insured Healthcare With Ashley Bacot
It’s great to be with you all. I’m honored to be joined by some friends of mine that you’re very familiar with, Dr. Darin Vercillo and Ben Sawyer. Darin and Ben are both executives at ABOUT Healthcare. It’s great to see you guys again.
It’s good to see you, Chuck.
It’s good to be here, Chuck.
Over the past several episodes, we have been discussing some newer innovative models of healthcare, including the emergence of payer-provider or payviders, partnerships, and venture-backed physician group development like Oak Street Health. We will be talking about an employer-developed healthcare model that includes onsite primary care. We’re fortunate to have as our guest Mr. Ashley Bacot who is the president of ProvInsure.
We will talk a little bit about what ProvInsure is and what the model looks like. Ashley has played an integral role in helping Rosen Hotels & Resorts develop a cutting-edge self-insured healthcare model in and around the Orlando area. That includes onsite primary care. This program has reduced the company’s healthcare costs to a mere fraction of its competitors while at the same time providing benefits that are far superior.
Ashley has been instrumental in attracting national attention to this model with visits from the Chairman of the Congressional Subcommittee on Health, Katie Couric at CBS News, FOX & Friends, and CNN to mention a few. This model has saved Rosen Hotels & Resorts over $500 million since its inception. It could reduce the nation’s healthcare cost by $1.5 trillion annually. A lot of you are at hospitals and healthcare systems coming out of COVID, we understand the stress and strain you’re under.
We feel one of our responsibilities and the things that we like to do is to bring you lots of different alternative ideas and things that are going on in different parts of the country that may be useful to you as you think about new models and go forward. Ashley, it’s great to have you with us. Thanks for being here. For the audience, Ashley and his family live in Orlando. They managed to escape the worst of the hurricane but we appreciate you taking the time, Ashley. Thanks again for being our guest.
Thanks for having me. I’m looking forward to this.
Let’s start briefly if you wouldn’t mind describing the history of ProvInsure and RosenCare. People may not be familiar with the size of that organization, your organization, and things like how it was started, why it was started by RosenCare, how it has been received by employers, and what some of the results have been.
I’ll go in chronological order. Rosen Hotels came first and then ProvInsure. Rosen Hotels is the largest independent hotelier in the Southeast US. All of our properties are in the Central Florida area. I’m going to speak in pre-COVID numbers because our number of employees went down. I want to talk pre-COVID because that’s where we will be back to before hopefully too much longer.
Rosen Hotels has 6,000 covered employees and dependents on its health insurance plan. I’ll get into the details of that in a minute. Rosen Hotels has been around for many years. ProvInsure is a risk management consulting and insurance agency that grew out of Rosen Hotels Risk Management department years ago. What it does in a nutshell is to help other employers implement solutions that are exactly like Rosen has or maybe certain components of the Rosen Healthcare Plan.
RosenCare came about through frustration with the way healthcare is trending. Years ago, we were at Rosen Hotels. We were hoping that our renewal premiums for a fully insured health plan with a large national carrier would go down because we had implemented some wellness programs and some things that show that our claims volume was much less than the premiums we were paying. We were hoping for this nice reduction in premium.
When the insurance carrier met with us, they said that our premiums were going up. We were frustrated. We said, “We don’t understand because our claims are much lower than the premiums that we’re paying.” They said, “The group that you were in didn’t perform too well.” We said, “What group? We didn’t know we were in a group.” They said, “You’re in a group.” We said, “Moving forward, we don’t want to be in the group anymore.” They said, “It doesn’t exactly work that way. You have to be in the group.”
Mr. Rosen said, “I’m not going to do this. This is ridiculous.” He told the insurance company. He looked at the last five years of his premiums and the per-covered life cost that he’s experiencing. It doesn’t look sustainable. It’s quite a threat to his hotel organization to continue having his second largest line out of expense after wages increase at a rate that’s 3, 4, 5, and 6 times CPI. Ms. Rosen says, “I’m done here.”
We became self-insured. We opened our onsite clinic. I’ll get into some details of that. We hired an independent third-party administrator and cut direct contracts with the local hospital chain and physicians in the area. We were off and running. That is what we think is the formula for success. It’s to do something similar to that. It doesn’t have to be all of those components. You don’t have to have the onsite clinic and certain things but certainly have an independent third-party administrator and a strong focus on primary care, whether you do bricks and mortar with your docs or you use others or you use direct primary care docs.
That was by accident. When we opened our site clinic and became self-insured, we were talking to a lot of smart folks, and some mentioned things like this. That’s the direction we went. We got lucky. At RosenCare, our cost is about half of what our identical demographic would have in the traditional healthcare setting of a large national insurance company while our benefits are far richer than most. When I say richer, there is zero deductible and no co-insurance. 90% of our drugs are at a zero copay. That’s what I mean by richer benefits.
You mentioned the $500 million in savings. I mentioned the costs were about half of what they would be elsewhere. We were measuring hard costs. We have not measured the soft costs associated. For example, Rosen Hotels’ turnover is about 14%, whereas the national average in our peers is 35%, 45%, or up to 75%. Not having to retrain folks and having folks that are going to the doctors, seeking care, getting back quickly because we have our onsite clinic, and coordinating care between all of the specialists, there’s an increased amount of productivity there.
We have not added that into the mix. I suspect that’s a needle mover in itself but we have not measured those numbers. Going back to ProvInsure, for many years, we were giving away our secret sauce for free and hoping other employers would do what we’re doing. They would tell 10 employers who tell 10 employers. Through a groundswell and grassroots-type movement, we would change the face of healthcare in America. That did not work.
We started consulting. That seems to be moving the needle a little bit more. One of our first clients following the Rosen model is a large school system with about 10,000 covered lives. We are on track to save them about $100 million over the first five years. It’s interesting. We take some of our savings and invest it back into the community. We have adopted underserved neighborhoods that were infested with prime that had graduated from high school with rates of 50%. We have invested in those communities and turned them into almost no crime and 100% graduation from high school.
We pay for their college. When they graduate high school, we use our savings to pay for their college education. We also use the savings to pay for the 2, 3, and 4-year-olds in these communities for their daycare. When they come to our daycare facilities, we tutor them. When they enter kindergarten, they’re sponges. It doesn’t matter whether you come from low socioeconomics or not. The brain is the brain. They start reading better than my kids started reading. That’s a little bit about that.
It doesn't matter whether you come from low socioeconomics; the brain is the brain, and they are sponges. Click To TweetI’m curious. Our audience has a sense of this. What’s the size of the geography around Orlando that you have covered lives in?
In the tri-county area, there are three large counties, Orange, Osceola, and Seminole. That’s where most of our employees are. Our model is constructed to take care of employees in a tight area. When we work with other employers, sometimes they’re spread out all over the country. We don’t have bricks and mortar for their primary care. We have advanced direct primary care docs that are available.
This is fascinating. I want to ask you a few questions about the construction of the plan. You have a stop-loss carrier for catastrophic. Is that at a $1 million per individual and $10 million per group attachment point? How are you running the catastrophic?
As it relates to Rosen, we are in the $700,000 to $750,000 range per individual. There’s no aggregate. Our claims are pretty predictable. That’s where we are. Every employer’s risk tolerance is different. We have some employers that want less and some more.
Is your third-party administrator primarily doing claims adjudication? Are they helping you with benefit plan design?
We work with them a little bit on plan design but for the most part, we handle the plan design at ProvInsure.
Do you create narrow networks of providers based on performance so you have an internal panel and an external panel of providers that are not in the plan? How does that work in terms of where your employees can go to?
It varies by the employer that we consult with but as it specifically relates to RosenCare at our primary care facility, we use various methods of empirical evidence for doctor quality and outcomes. We direct our employees to those facilities. We give some of our other clients the option. If they say, “I’ve always gone to Dr. Smith. She’s the best,” although we know that Dr. Smith is the worst, they will continue paying the deductibles and out-of-pocket they used to pay before we redesign their plan. If they want to pull the right levers, go to the right docs, and still have a choice among the 2 or 3 docs that we provide them that are the best for their particular condition, that’s when they go in for a very low or no out-of-pocket cost.
Darin has some questions. I’m going to ask another. Are there any incentives in your provider network? Do you use withholds or other types of incentives for your in-plan network, whether hospitals or specialty positions?
Are those incentives for the employee to choose the facility?
It’s for the provider to participate and provide, for example, access to your employees or your client’s employees.
We do tier them. The docs and facilities that have higher outcomes and better quality are in preferred tiers where the employee doesn’t have to pay as much. It’s going to steer more people to those particular providers.
The incentive is primarily volume on the part of these providers that are participating.
The hospitals, for example, will accept a lower unit cost for more volume.
Thanks. Congratulations on the success of what you’re doing from a clinical standpoint, the impact on the lives of the people that are participating, and the financial impact. The sounds like it’s a win-win all the way around. I want to ask you a quick question. A colleague of mine, Donna Milavetz, here in Utah, a physician, started a company called OnSite Care. It’s providing onsite clinical care for companies that wanted to bring that in, self-insure, and provide that. It ultimately was acquired by Steward Health Care.
I’m curious about your point of view. This came out of Rosen, the hotel corporation. Flipping that around since many of those who are reading this are healthcare leaders, do you see an opportunity for healthcare organizations to branch out of their bricks and mortar, “If you build it, they will come to my clinic or my hospital,” and then start pushing out this organizational offering to larger employers?
They generate those relationships oftentimes with larger employers in the area but do you see an opportunity for them to partner to provide this same model and drive that out to employers, potentially overcoming what you mentioned? Why didn’t it change healthcare? Could it be pushed from a different side and maybe get more adoption?
Having the hospitals and providers coming directly to employers and engaging employers is exactly what employers are looking for. It’s for folks to come directly to them. They prefer a direct relationship as opposed to working through, sometimes and this is not always the case, middle people who don’t bring a lot of value.
I would assume that as you tried to go out or you wanted to see whether or not this was going to change the face of healthcare, there are probably a lot of employers and companies out there that have a degree of trepidation about jumping into this thing because of the risk and the unfamiliarity with running that model and having healthcare organizations come to them with something maybe a little more turnkey and organized for them. It might then snowball, and you might see more companies adopt that thing.
A lot of innovation will be spawned by that interaction between the employer and those providers because the employer is going to express to those providers and facilities what their needs are and their frustrations are hopefully without having to go through the bureaucracy of middle people. That provider organization can cut through all the barriers and provide that employer exactly what they need. As far as trepidation, when we entered this years ago, there was a reason to be concerned but these days, there are folks like me. I’m not the only person in the country that gives guidance to employers to do plans like this. There are many folks out there who can hold the employer’s hand. It’s not that scary anymore.
That’s great to know. Thank you. It sounds like there’s an opportunity.
Ashley, can you give for the audience’s sake a little bit of a comparison cost per covered life or cost per family unit in your model versus the traditional insured model?
It all depends on the makeup of your employee or group. When I mention a number that I’m getting ready to mention, and I’m very proud of this number that I’m going to mention, an employer who has a much younger population and skewed younger male versus female might go, “That’s a large number. I can get my insurance for less.”
You need to take demographics into consideration because our demographic is a sick demographic and is more of a Medicaid demographic but our costs are right around the $6,500 per covered life range. Ours would be a little over $13,000 for that employee in the traditional healthcare setting but the good news about our model is that regardless of what your cost is in the traditional healthcare model, we should be able to reduce that by 30% to 50% no matter what your cost is in the traditional model.
I’m curious. How does the onsite clinic work? How has that been instrumental in some of the cost control? There are large employers out there that are going to this model in terms of the onsite clinic. I’ve been doing this for a long time and I was involved in some onsite work as well. Most of the employers that I’m aware of have found pretty dramatic results from having done this. You wonder why more aren’t doing this. What did you find as the biggest advantages of having some of the onsite primary care?
When we first started years ago, it was basic primary care. We have bolted onto it over the years. It’s much more than me. I’m the face here in this particular presentation but our folks at our medical center, finance, Rosen, and human resources have all worked together and brainstormed this over the years. It started with basic primary care in about a 700-square-foot setting. Now, it’s about 12,000 square feet. We have MDs, DOs, PAs, nurse practitioners, virtual care, a chiropractor, a podiatrist, and a radiologist. The list goes on and on.
The value that we get out of primary care is in the traditional healthcare model, the last sliver of the healthcare dollar is given to primary care. I’m oversimplifying this. I don’t want to offend anybody. They can’t do much more than listen to the person and refer them out to the best provider. We have learned that probably 80% of our folks can get all of their care at our primary care facility if we spend some time with them and invest. Whenever our primary care providers say, “We need this or that,” we pretty much give it to them because for every $1 we put in, we get about $7.50 back. In essence, there is a tremendous amount of value coming out of prevention and care coordination.
There is a tremendous amount of value coming out of prevention and care coordination. Click To TweetHere’s one other question I have, and then I’ll turn it back over to Ben. Darin and I are both internists. In our many years of having been in practice, Darin still sees patients dealing with the insurance company, whether it’s UM, medical necessity, and all those kinds of things. Darin still has a beautiful full head of hair but I don’t. That’s part of the reason. I’m curious. What relationships do you have with specialists and primary care physicians out in the community? You have some people nationwide. How do you make their lives easier? Why do they want to work with RosenCare and ProvInsure?
Typically, the primary care folks want to work because they get to do what they have always wanted to do, and that’s to take care of people. We give them the tools to spend as much time as they want to with patients and not have that lingering thought, “I haven’t spent enough time with this patient. Am I going to have a MedMal claim?” We give them peace of mind and quality of life. We are paying specialists more than they were making before because we want them to want to use our model and be engaged with our model.
When we pay them more, they’re able to have additional tools to take care of folks. Although we do look at bills that are submitted to be sure they’re done accurately, one anecdotal bit of information we get from our specialists and providers wherever we do business is that we don’t seem to put them through the wringer as other insurance companies do regarding, “You didn’t do this and that.” Overall, they know that this model that they are a part of is making people healthier and able to reach out to people who were not able to get care in the past. It makes them feel warm.
There are a couple of other quick questions. You talked about case management or a care orchestration model. Do you have case managers and/or social workers that are available as necessary to help manage the case? That’s question one. Question two was this. You seem to have developed some breakthroughs in pharmaceutical costs. Can you speak to those quickly before we wrap?
We have case management and social workers. That is something that we have added over the years. We build strong relationships between our case managers, our social workers, and our employees and their families. That’s the root. If we build a strong relationship, they will want to take care of themselves and follow the care direction that we have provided.
As it relates to the pharmacy, that’s interesting. In 2005-ish, we came across an article or something. It mentioned getting drugs from Canada. That’s where we started our pharmacy. We have a pharmacy at our onsite clinic. That’s where we got started with reducing our costs in pharmacy by about 50% to 60%. I shared the idea with Mr. Rosen. He liked the idea and asked me to share it at a leadership meeting where all of my peers are. My peers agreed that it was a great idea. Mr. Rosen goes, “If it is a great idea, I want the people in this room to be the guinea pigs for the first year.” That’s when everybody went, “I hope it is a good idea.”
We were guinea pigs in management for a year. That started our little exploration going deeper into how we can save money on the pharmacy side. We are getting patients that sometimes have a drug that costs $50,000 or $100,000 a year. A lot of times, we’re getting that for zero cost. I would love to get into the details at a later date on the pharmacy but we get everything that you need for about half the price.
Thanks again so much for taking the time. This has been illuminating. I’m sure that some in our audience might have some questions. It’s Ashley Bacot. He is the CEO of ProvInsure in Orlando, part of RosenCare. If anybody in the audience has any questions or wants to know more about this model, I’m sure that he would be happy to answer those questions. Thanks again for your time, Ashley. Ben, do you have any comments you would like to make about the future episodes that are coming up?
We have a CEO innovation roundtable that’s coming up on November 17th and 18th, 2022. We will be talking about innovation and the new transformation model based on all these changes that have been happening and that we have been discussing during the pandemic. We look forward to those CEOs and COOs who are interested in joining. It’s a limited event. We’re not having any more than fifteen CEOs and/or their COOs who represent them participate. If you’re interested in that, reach out to Erin Sellers who is the Senior Event Coordinator at Baldrige Foundation. You could reach her at ESellers@BaldrigeFoundation.org.
Thanks again, everybody. We look forward to seeing and hearing from you. We hope you join us for our future episodes and meetings.
Thanks, Chuck.
Thanks for having me.
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We finished a fascinating conversation with Ashley Bacot, the CEO of ProvInsure, which is part of the RosenCare and Rosen Hotels company in Central Florida. It’s interesting that what goes around comes around in a sense. Ben, you were talking about your experience with trying to work with a health system years ago on direct-to-employer contracting. I’ve been talking about direct-to-employer for years. People think it’s this big black box.
What’s so interesting is that the employers are driving this as Rosen Hotels did years ago and the CEO of that company saying, “Enough is enough. Our premiums keep going up even though our claims cost keep going down. There has to be a better way,” and developing a program that saved Rosen Hotels along with 6,000 employees, not to mention all the employers that they’re now ensuring as well.
Over $500 million is a pretty amazing statistic. Having the cost per case be half of what it is with traditional insurance, taking those dollars, pumping it into the local communities, helping those communities, paying for college tuition, and having childcare for some of those children in those communities is an amazing story.
The thing that’s so surprising about all of this is that it makes so much sense. You wonder why more people aren’t taking the leap of faith and trying something like this. You have to scratch your head. This isn’t rocket science. Why don’t we try something new and see if it might help bring down some of the costs and improve the quality? What are your thoughts, Ben?
We have become so in tune with third-party payment systems in healthcare that the idea of directly dealing with our primary customers is somewhat of a new thing and yet is very powerful. That has been true in every capitalistic model. The best outcomes in terms of price and satisfaction are when you’re dealing directly with your consumer.
For the audience, Dr. Paul Keckley, who will be our keynote for the CEO Innovation Council coming up on November 17th and 18th, 2022 that leaders will want to take a look at participating, is going to be speaking more about this because there has been a growing trend as he mentioned on his podcast of employers saying, “Enough is enough.”
They are working on dealing directly with health systems and creating different accountable and collaborative models. It is an area of real opportunity for health systems. It would enable them to be able to compete more effectively within their catchment area. This innovative conversation can be helpful.
I echo everything that has been said. What a tremendously enlightening episode we had with Ashley. As we talked about true innovation, innovation doesn’t have to be complex. It doesn’t have to be a groundbreaking new idea that has never been thought of before or some technology that didn’t exist like a new iPhone. This is very straightforward and yet so effective. To hear the trifecta of success that they have had with providing better care and making it more convenient reducing cost, this is something that everybody would want to know about.
Having a personal experience with another colleague who provided this capability to employers, this is something that leaders across healthcare and anybody involved with it are going to want to pay attention to, especially since as Ashley said during the presentation that there are consultants and hard data that they can avail themselves of that take the risk out of it. It’s super beneficial. I look forward to hearing the comments that people have as they read this and think about applying it in their careers.
