Dip Your Toe in the Water

For decades, employer-sponsored healthcare has felt like an uncontrollable fixed expense. Companies face double-digit increases from brokers blaming rising costs within traditional risk pools. Ashley Bacot, architect of the legendary RosenCare program at Rosen Hotels & Resorts, joined a recent episode of Moving to Value Unscripted to discuss how employers can begin to break free from that system.

RosenCare bypasses traditional insurance carriers to prioritize patient-provider relationships over administrative profit. While national healthcare costs escalate, the RosenCare model keeps expenses at roughly half the national average without sacrificing quality. To date, the program has saved Rosen more than $500 million. Ashley identified key strategies that even small and mid-size employers can implement to help reshape healthcare in America.

1. Shift Your Mindset

Most executive teams view healthcare as a fixed overhead expense like rent. In reality, up to 90 percent of healthcare expenses are highly variable. If you start to treat healthcare as a variable expense rather than a passive monthly bill, it makes sense to shop for the best prices, negotiate directly and demand total data transparency.

2. Dip Your Toe in the Water

Overhauling an entire corporate benefits package at once can overwhelm benefits managers. You can begin incrementally by targeting areas where you can secure immediate, high-impact momentum. One great catalyst is specialty Rx:

• Pharmacy spending represents about a quarter of an employer's total healthcare dollar, and specialty medications account for roughly 60 percent of that pharmacy spend, but only 1 to 3 percent of an employee population utilizes these drugs. 

• By demanding transparency in the specialty pharmacy tier, you can capture significant cost savings while disrupting only a fraction of your workforce. This initial win can help you build confidence to take bigger swings.

3. Establish a Self-Funded Structure

To scale a value-based model, you need to stop relying on traditional commercial health insurance infrastructure. This requires migrating away from fully insured corporate pools and moving toward a self-insured or level-funded framework.

The operational anchor of this shift is partnering with an independent third-party administrator (TPA). Traditional insurance giants often shield data in proprietary networks, forcing employers to manage benefits blindly. An independent TPA grants you total visibility into your data stack, enabling you to track exact claim sources, operational waste and systemic financial leakages.

4. Deploy Strategic Direct Contracting

When Rosen first launched an independent model, it bypassed traditional insurance networks and negotiated directly with local hospital systems. By designing a plan with $0 deductibles and $0 coinsurance, Rosen could promise clean, guaranteed payments. In exchange, providers offered lower direct contractual rates. This arrangement can help eliminate administrative hurdles like prior authorizations.

5. Elevate Primary Care and Prevention

A deep investment in advanced primary care is at the center of RosenCare’s success. Rosen provides its workforce with unlimited on-the-clock primary care access.

You might worry that removing financial barriers could trigger runaway utilization, the data say otherwise. By reducing patient-to-doctor ratios, salaried physicians can spend meaningful time with employees. Strong patient-provider relationships have propelled Rosen’s compliance rates for chronic illnesses to two to two-and-a-half times the national average. Managing conditions early can prevent catastrophic, high-cost emergencies down the line.

Replicating the Model

Ashley highlights that the blueprint is replicable across industries. For instance, a large public school district facing financial headwinds successfully mapped the RosenCare model onto a complex public-sector environment and has since avoided $100 million in healthcare costs.

Ultimately, Ashley believes grassroots execution from employers will be more effective in changing American healthcare than a national political solution. You can dip a toe in the water, stop accepting the status quo and start actively fixing your healthcare supply chain.

Catch our full conversation with Ashley to learn more.

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