Scaling Up Self-Funded Employer-Led Healthcare (feat. Ashley Bacot)

TRANSCRIPT

Click here to listen to the episode, published June 9, 2026.

ASHLEY [INTRO]: They come from a lineage of cowboys. They take risks. They're tough. And that's what was needed to get this thing done. … It's almost like an abusive relationship. These employers that are protecting the very entities that are causing them the most harm and they're saying, "Next year, I don't think it's going to hurt as much." … We fixed our healthcare and saved money and got to use that money to fix other stuff. … Just trying to inspire other employers to do this, I think, is critical to changing the face of healthcare in America.

JOHN: Thanks for joining us for another episode of Moving to Value Unscripted. My name is Dr. John RodIs, and I'm a recovering ex-hospital president and the president of Moving to Value Alliance. Our mission is to advocate for a value-based healthcare ecosystem with the highest quality outcomes at a reasonable cost for our communities. I want to thank our members whose support makes this podcast possible. We'd like to give special recognition today to our trade member, Connecticut Joint Replacement Surgeons, LLC. I'm joined by my fellow board members, Lisa Trumble, Kim Lynch, and Donovan Pyle.

LISA: Hi, I'm Lisa Trumble. I'm the president and CEO of Southern New England Healthcare Organization. We're based here in Windsor, Connecticut. We're a physician-led, clinically integrated network focused on population health and value-based care in both Connecticut and Massachusetts.

KIM: I'm Kim Lynch, founder and CEO of Metis Health Technologies, where we help clinicians and healthcare organizations streamline operations, increase revenue, and deliver better patient care. I'm originally from Michigan, now based in D.C.

DONOVAN: And I'm Donovan Pyle, CEO and founder of Health Compass Consulting, author of Fixing Healthcare, and senior advisor at the Validation Institute in Boston.

JOHN: Our guest today is Ashley Bacot, the health plan architect of RosenSure, which serves Rosen Hotels and Resorts in Orlando, Florida. Ashley has spent more than two decades as the chief architect and strategist behind the world-renowned RosenCare model, which operates on the principle that employers, not traditional insurance carriers, should act as the stewards of employee health. Rosen provides unlimited free primary care visits for all employees, free physicals and health screenings, $0 copays for many services and prescriptions, negotiated direct contracts for most major procedures, on-site fitness, flu shots, vaccines, family planning, nutritional services, and more. The model is revolutionary, to say the least, and it works. As most employers brace for double-digit premium increases, Ashley manages a system where costs remain roughly half the national averages without sacrificing quality. Since its inception, the model has saved Rosen more than half a billion dollars. That's $500 million, which the company has reinvested in other employee health benefits like free daycare, preschool, and even college tuition, as well as programs to reduce crime, boost high school graduation rates, and more. It's no wonder that Rosen sees strong employee satisfaction and retention. Under Ashley's leadership, the model has become a national blueprint for sustainable, value-based healthcare that prioritizes patient-provider relationships over administrative profit. He joins us to discuss how this model could scale to transform healthcare in the country. Welcome to Moving to Value on Scripted, Ashley.

ASHLEY: Thank you for having me today.

JOHN: So Ashley, you know, we're all big fans of Rosen Hotels and what they have done. And they did it before, you know, almost before some of us were born. I was delivering babies, I think, when Harris Rosen had the idea to start doing what you guys have done. So just tell us a little bit. You kind of come from a, if I understand, your background is kind of risk management. So tell me a little bit about and tell our listeners your journey of, kind of how you started to Harris Rosen and how you got here today. And we're really honored to have you, by the way.

ASHLEY: Thank you. Thank you. Yeah, I came on board as his risk manager almost 30 years ago. And he had a property and casualty insurance agency. And I was a property and casualty insurance guy, not a health insurance guy. He, in the interview, he said, well, hey, I also, you know, have this kind of health care program that we just kind of started doing and I'd like for you to kind of oversee that. You know, do you know much about that? And I think I probably fibbed and said, sure. And, you know, as soon as I got out of the interview, I called my health insurance friends and says, please smarten me up. And so the program had already been started by the time I got there. Over the years, I've played a role and with a lot of other folks within the Rosen organization, our human resources department, our finance department, et cetera, and just played a role in incrementally building upon what we first started out as. And we've become, I think, somewhat of a model that could be replicated.

JOHN: Well, I think you’re being humble there. I would think we would all say you guys are the gold standard for what any employer should achieve. So, yeah, thank you for that. Let me, if I can, just follow up. I've said as a former employer, who has the health of my employees more in mind than me? Because I care about them. And I pay their insurance, or at least they pay a lot of their health insurance costs. So the health and wellness of them is critical to me. But I didn't do anything about it, truthfully. Yeah, maybe I changed the food in the cafeteria and I put the water in more prominent positions, but Harris Rosen took it to a whole other level. So maybe just share some of that, how it started and how it evolved a little bit.

ASHLEY: Yeah, so in 1991, October of 91, Rosen Hotels was hoping that their insurance renewal would be, would have a decrease because the claims that had been paid out that previous year were much less, much less than the premiums that were paid in. And the the health insurance broker came in with an increase. And Harris Rosen said, what you know what's going on that that's we had great experience. He goes, absolutely, you did. Rosen Hotels did. But you were in a pool, and the pool did not have a good experience. And so Harris Rosen said, hey, I didn't know I was in a pool. I don't want to be in the pool anymore. I'd like to stand on my own, you know. And they said, no, you have to be in the pool. And so he decided to kind of get out. It was just, it was not, John, it was not sustainable. The consumer price index averages probably, I'm guessing, 3% over the years, and healthcare was at 6, 9, 12, 15, 20, and it just simply was not sustainable. And so what he did is what some people are doing today that is really providing a lot of good results. And he didn't do it because we were clairvoyant. I think, listen, he was an incredibly bright, intuitive, you know, person. But I think we also got kind of lucky that we did what we did. So we became self-insured, hired an independent third-party administrator, started doing direct contracts with the hospital and providers in the area and had a RX, you know, carve out and then had our kind of the hub of the whole thing is our on-site advanced primary care medical center that at that time wasn't an advanced primary care medical center. It was, we were just opening the doors and didn't know what we were doing. And we had a smart doc who was providing, you know, basic, you know, primary care. That's how we got started, we don't have any deductibles. We don't have any co-insurance. 90% of our drugs are at no co-pay. But on the direct contract side, when we were talking to the hospital trying to get a better rate, they just happened to hear us talk about how we weren't going to have any deductibles and no co-insurance. And they said, whoa, kind of repeat that again? And we said, yeah, no, no deductibles, no co-insurance. And they said, well, we spend a disproportionate amount of a dollar trying to chase deductibles and co-insurance.

JOHN: Right.

ASHLEY: So if you don't have any of those, if you're sending us people, we don't have to have our accounts receivable department looking for money. We can give you a better rate. And so that, you know, that lent itself to getting us a better rate.

JOHN: Right.

ASHLEY: For example, I remember our first direct contract with a provider was a gastroenterologist in town. It was Harris Rosen's gastroenterologist. Now it's mine. And he's a little bit — he's a nice guy, but he can be a little grouchy kind of. And so he was kind of, I think, maybe a little irritated. Why are you in my office today? And we said we wanted to do a direct contract. And he said, well, you know, you don't have the critical mass to give me lots of patients or whatever. And so, yeah, but we'll give you, I think, a great experience. Just tell us what drives you crazy about the, you know, insurance companies that you deal with. And we'll try to remove all of that. And that got his attention.

JOHN: Right.

ASHLEY: And so we also said, you know, just, you know, we're not going to argue about payment. Just send us an Excel spreadsheet de-identified and, you know, we'll just — we'll send you money. And we're not going to get upset about anything. If we compare it to past utilization and something looks weird and odd, we'll ask commonsensical questions and we'll right the ship if it needs to be corrected whatsoever. So he liked the commonsensical approach to that. And then he said, he said, this doesn't happen all the time, but let me give you an example. He said, I've got to listen to, you know, Susie in Idaho who's telling me if I can do something on a patient. Susie doesn't even have a medical degree. And that drives me nuts. And we said, we'll remove that. If we, you know, we'll maybe audit you every few years. And we find out if you're doing something wacky that's not appropriate, we'll maybe end the relationship with you. But we're not going to have, you know, Susie or Jim, you know, dictate what's going to —

JOHN: No more prior authorization.

ASHLEY: Yeah. And so he said, one example is when we do a colonoscopy, you've done all your prep. We got the, you've already been anesthetized. We've already, we've spent our time, you've spent your time getting this thing ready to go. We do the colonoscopy and we find out, oops, we need to do an endoscopy. I have to go back to Susie and say, can I do this? And so you got to go through all the prep. You got to pay for the anesthesia again. And so we said, we're not going to do any of that stuff. So anyway, that kind of — that set the stage for things there. On the Rx side of things, we were one of the first to enter into international pharmacy, and that has saved a lot of money over the years. And so, you know, the same medication that I go down to CVS and get, I can get it for half price, you know, somewhere else. And so that was an interesting story in that Harris Rosen sent me a periodical and said, hey, people are buying drugs from Canada for cheap. And so I got the article. I read it. I called, you know, the folks in Canada. I said, hey, you know, can we do this? And they said yes. And we did a little bit more due diligence. And I brought it back to Harris Rosen. I said, yeah, I think we can do this and we can save X. And he said, well, let's bring it before the leadership team at Rosen Hotels and brought it before the leadership team. And Harris Rosen said, Ashley, kind of tell the team about this. And they go, oh, my God, Ash, that's perfect, that's genius, we need to do that. Now, listen, they were fellow leadership folks propping me up and being kind. That's what that really amounted to. And Harris Rosen said, listen, that's awesome that you think, you know, that's genius because I'm not about to unleash this on my 6,000 covered lives, you know, because Ashley said it's a good idea. You guys are going to do this. You’re the leadership team. You'll be the guinea pigs and you'll do this. And then there was some, you know — then I got a lot of questions afterwards, an extreme amount of due diligence from my friends who easily, you know, said that I was the genius.

JOHN: That’s funny.

ASHLEY: So anyway, the primary care, it just started very simple. It was a laser focus on prevention. And we spend a disproportionate amount of our health care dollar on primary care. And we spend a disproportionate amount of our previous time being just a basic primary care provider and spending a lot of time with a patient. And so we quickly found out we need a lot more doctors and a lot fewer patients to be seen by those doctors each day. We did not know this at the time, but our compliance rates with diabetes, with cholesterol, with hypertension are about two to two and a half times the national average. And a lot of that is due to that relationship between the patient and the provider. When you have more than three minutes or four minutes with a provider, you kind of build some trust. And not that trust can't be built in three to four minutes, but you follow me. I think we attribute a lot of our success to that.

LISA: Ashley, it's certainly a remarkable effort and level of outcomes that you've had for your organization. And I'm sure employers that are listening that aren't steeped in health care at all, like you all were at the beginning, are wondering what's the best way to start, right? You kind of walk through it a little bit, but it's really hard as an employer where healthcare is not your number one thing, right? You know, maybe you're selling something completely different, but your costs are escalating. You got to figure out how to get your arms around it. If you could like simply lay out kind of the steps you took, that might be helpful for our audience to understand because you've done this since 1991. So it's evolved over a long period of time. It wasn't done like overnight and it's not an overnight type of fix because you're talking about a lot of individual contracting that's occurred as part of the process.

ASHLEY: It's a great question. And when we entered the fray, we didn't know what we were doing. And we were just asking people in the community for help. And we got some help and we kind of got through this. But now if an employer wanted to do something like this, there are lots of, you know, bright people, advisors around the country. Now, listen, it's a small subset of all advisors, but there are folks around the country that can hold their hand and take them through the process instead of us when we were going through uncharted territory. But I think the first thing to do, you need to ideally become self-insured, okay? Ideally, you can do it with level funding, but become self-insured. An independent third-party administrator is a key part of this. Tapping into some type of direct contract is very helpful. And having a transparent RX program, I think, is helpful. But I think when people hear about our story, they think we did it all overnight. And it's overwhelming. And even with help from an advisor, I think they still feel a little overwhelmed. And what I try to convince people to do is just dip their toe in the water. And I think one really cool way to do it — and Donovan, I've known Donovan for several years, and Donovan, we're all creative and a little bit different in our creativity, and he may have other thoughts about this. But one thing that I think is very seamless that you can get significant savings that will give you the — that will become the catalyst to do more and more things and will give you the comfort and kind of confidence to take another — to dip another toe in the water. And that is a specialty RX. Okay. So your RX is 20 to 25 percent of your healthcare dollar and specialty is 60-ish percent of the pharmacy dollar, but there are only one to 3 percent of your population that are using those. So you're only going to, if you call it disrupt, one to 3 percent of the people. So in a thousand employee group, what is that? 10 to 30 people I think would be affected by it. And you have this great savings.

JOHN: Right.

ASHLEY: And so if you do that, it's kind of seamless. You have this great savings and you have a little confidence and you go, wow, I think I'm going to do the next thing. Or you may go, wow, I'm going all in. A lot of different ways to do it. But I would just, I get concerned with, I think a lot of employers are good people. They don't want to disrupt things and do things a lot different, maybe along the lines, if you hire IBM, you don't get fired, that sort of a thing. But I think they, I think they just need to, I think dipping their toe in the water would be a, would be a good, would be a good start.

KIM: I love that, Ashley. And I also really love your point of you don't need to have it figured out. We were, you know, taking shots in the dark initially. And now there is a much clearer, repeatable pattern, exactly as you said, of investing in primary care, doing some direct contracting, the independent TPA. I'm curious, building on this, is there a minimum viable version of RosenCare? Is it, you know, you've got to have 100 employees? Is it, this could work for 50 employees? What's, what's kind of that minimum bar? And then a follow up is what do you say when you're talking to the CFO that says, this sounds crazy. Free primary care sounds like runaway utilization. How do you shut that down?

ASHLEY: Yeah. As far as the number of folks, I think you're going to hear a lot of different things from different advisors, right? I know someone who's doing it with eight folks.

KIM: Eight.

ASHLEY: Eight. But the but to that is, if I, as an advisor, am trying to help someone, sometimes a 50 life, you know, group, although it's easily doable, right? It takes up just as much time as a 500 life group. Okay. And so I think there is this right now, I think there's this move to, hey, we're trying to, we're, we're going against headwinds with a status quo trying to crush us and pushing, you know, programs like this away? How can we affect as many people as possible? And so I think you're going to hear a lot of folks have 200, you know, 300, but it really can be done. And I think that provides hope. It really can be done with as few as, you know, eight folks. But my hunch is in order to get this ball rolling, you're going to see a lot of advisors focusing their time of maybe 100 lives or above, something like that.

KIM: That is really hopeful. That is a really exciting thing to hear you say. And I'm curious, what do you say to the CFO who thinks this sounds like a runaway train of spend? All of this primary care isn't like, you're telling me this is going to cost less, but everything that I know, everything that I believe tells me that this is going to shoot my costs to the moon.

ASHLEY: So when we tell the CFO, you know, you can reduce. Now, Rosen's different. We've had time to refine and we're about half the cost. But, you know, I think the number out there is probably somewhere between 20 and 40 percent because some employers are not as aggressive as others. Maybe you could say 10 to 40 percent. But when we tell that CFO no deductibles, no coinsurance, 90 percent of the drugs are free. We're going to be spending a bunch of money on primary care. They initially just go, who are you? You don't sound credible. This sounds nuts. And once we have a chance to just show them behind the scenes how the current system works and details of how the other system works, they get it. They get it.

KIM: But you've got to show those specific trade-offs of here's how the current system operates. And here's what happens without co-pays. Here's the access. Here's how things change in this different world.

ASHLEY: Absolutely. And I think a lot of employers are — they got a lot of stuff on their desk. Right. We've all got a lot of stuff on our desk. We want to check our little boxes. It's Friday, by the way. We'll check our little boxes and go home for the weekend. And maybe people in Washington will figure this out and kind of bring it to us in a little box. Right. With a pretty little bow on it. I think that's somewhat of a problem, too. And I, you know, I think we just need to, you know, every employer, that eight person group, that 50 person group, that 10,000 person group that does this and has a good experience with it. And they tell 10 people who tell 10 people, I think that ground, you know, that grassroot type effort is what's going to change things. And so I think I would tell employers, you know, not only would we like you to kind of, you know, put your toe in the water and do something this year. You know what? No pressure. But you have an obligation. OK, if you're going to gripe about this is not sustainable, you can't wait for someone else to fix it. You know what I mean? And no offense. Listen, I've been on that side before. I've waited for people to fix stuff. You know, it's a hell of a lot easier that way. Trust me. But it's not the route.

LISA: There is no political will to want to fix this because nobody wants to put their neck out and do the difficult stuff that's going to tick off all their donors. Right? So, you know, waiting for that is a fool's errand. It's just not going to happen. Right? And in the meantime, we're going to get all these fragmented approaches to how to target it. So I do think it's going to have to start with employers saying we've had enough and we're going to do it our way. You know, much like you did. Can you give me some sense of how your outcomes are comparing to what's happening in the market today from like a cost to cost trend and like quality and experience perspective with your employees?

ASHLEY: So, you know, I can tell you, and listen, we haven't done deep, deep digging. Harvard Business School taught a class on us and came in and studied our stuff. We've had a few folks come in, but, you know, as far as quality, again, Our compliance rates with our patients on the primary care side are two to two and a half times the national average. We try to steer our employees to, if they're going to have a hip replacement, for example, we try to send them to high quality docs that just happen to be the lowest price. So we focus on quality first. And then, hey, if it happens to be half the price, we like to do that as well. And I haven't completely answered your question. Remind me of.

LISA: Yeah, I was wondering, you know, what kind of cost experience your plan is having, you know, compared to the market, you know, with other employers that are going the traditional way, seeing double digit premium increases or escalation in costs. What has your cost trend been like?

ASHLEY: Yeah, our trend, we had our ugliest year last year. So even when you're doing all the right things, you could have a really ugly year. The interesting thing is, if we would have been doing it the old way, this last year would have been twice as ugly. And that would have been crippling to our company. But our cost trends have been relatively flat to maybe CPI-ish versus...

LISA: That's still good. That's great.

ASHLEY: And listen, once we went in and trimmed everything down, we do have to accept the fact that, you know, the providers and all the ancillary folks that we deal with, their costs go up each year. So we do have to deal with that. So there will be some slight, slight trend over long periods of time. But again, slight trend, sustainable trend, as opposed to unsustainable trend.

LISA: Yeah, yeah.

DONOVAN: Ashley, great seeing you. So much of this requires engagement from employees and buying from employees and their dependents. I want to get tactical for a second here. How does Rosen go about educating employees and getting their buy-in on all of these different pieces because the communication challenge is real and it doesn't matter if there's 50 employees or 50,000. How does Rosen go about doing that?

ASHLEY: A lot of that comes from two areas, our human resources department and our medical center. Human resources department is sending out wellness messages, providing wellness type initiatives, and it's coming from a lot of different angles, right? So when I see something from human resources that says, hey, we're going to do a run this weekend for this charitable organization, and it's going to do what Mr. Rosen would love to do. We get to give back to the community, and we get to run and get some exercise. Well, listen, that really doesn't appeal to me, okay? But one of the other 10, 15, 20 messages that I see a week might grab my attention. You know, the one that says, hey, instead of using the butter, you can use the olive oil, and I can still cook within this cultural mix of soup that I've been wanting to cook for years, and I don't have to change my whole recipe. So a lot is pushed out from human resources, and a lot comes from that trusting relationship with the provider that that doc has built. Health coaches, a lot of it, you know, comes from our health coaches, our nurses who are health coaches. So it comes from a lot of different angles. And I will tell you, as much as I would like to, you know, we hear a lot of folks say, oh, Rosen, how do you do it? How do you do this? How do you do that? We are not perfect. You know, I sometimes think that people think it's like a Beijing street corner, you know, where we're all in unison and we're doing, you know, all sorts of like good exercise. And man, Rosen's really got this thing perfected after, you know, 35 years. We're still dragging that horse, you know, to water and hoping they will drink and getting, you know, as creative as we possibly can in order to get people to do what we need to get them to do. So we're not perfect, but I think in aggregate, we're doing pretty well.

DONOVAN: It sounds like you're very intentional about the communication and it's almost like a marketing strategy. Like there's a campaign around all of this. You said 15 to 20 messages, emails a week. I mean, that's a tremendous amount of information being pushed out and it's coming from multiple angles. So do you look at it as a marketing campaign?

ASHLEY: You know, I guess it is. Listen, I mean, it is, we're in the healthcare business, basically. I mean, I thought that we were in the hotel business, but based on our spend, we're in the healthcare business and we have to have marketing strategies to work in that business and to thrive in that business. So yes, that's a, never thought of it that way, but yes, absolutely.

JOHN: It's like Warren Buffett said about General Motors, their healthcare business that makes cars on the side when you look at their spend? And so let me, if I can, pick up on Donovan's question a little bit, actually, because I think — and I'm going to go back and make a comment on your comment about CFOs too. When I try to talk to employers about this, and I put my old former employer hat on for a minute. I said, listen, 5,000 employees, a billion dollar annual revenue, $75 million healthcare spend. And by the way, like Harris, my broker came to me and said, oh, your premium is going to go up 10 percent. And when inflation was 2 percent for like five years in a row, I said, then why is it going up 10 percent? Inflation is like 2 percent. And try to bear in mind, I'm not in the hotel business. I'm in the freaking hospital healthcare business. And he goes, oh, it gave me the same spiel. Unlike Harris, I said, okay. And I paid 10 percent that year. And I think you guys did a lot. But so when I talk to finance CFOs and CEOs, I say the problem with you in large part is you think of your healthcare expense as a fixed expense. And when you're looking at your budget, fixed expense are fixed expenses. It's like rent. I got to pay it. It doesn't matter. If you start to, what you know, of course, that 70, 80, 90 percent of the expense in healthcare is actually variable. When you start thinking of variable expenses as a CFO, then you start thinking, oh, well, wait a minute, variable expenses. I shop for best price on variable expenses. And I think that's often a big part of that, to your point. And I love what you said about — take the first step. Now, if I can segue to my question, and it ties into your employee mix, a little bit of your geography, but also about the education. Health illiteracy is a huge issue in this country. I'm 70 now. And I have, you know, of course, when you're the doctor in the family, you're also trying to help people. And I can't convince half my family to have colonoscopies because they're like, oh, I hear they're dangerous. Or biopsies spread cancer. Or mammographies cause cancer. And it's like crazy, you know. And I'm like, I spent all this time trying to educate them and in large part fail to get people to do basic health and wellness. And you mentioned a couple of times now that your employees have twice as good as, you know, the national average. We should remember the national average for diabetes good control is 20 percent. So double is like 40 percent, which means there's still even half the patients with diabetes not being well managed. Hypertension in this country, 44 percent maybe are well managed. You guys are probably in the 80s, 90s. It's to your point. So tell us a little bit of an employee mix, because I think if I remember right, your employees are a little bit older. You have a lot of international employees, actually, right?

ASHLEY: Yes.

JOHN: So your challenges in some ways are even more than others. Comment a little bit about that.

ASHLEY: We have about a third of our employees from Haiti, a third of our employees speak Spanish from either here or recently from abroad. And, you know, a third kind of look like me. Each of those cultures have to be dealt with in a different way. And that's, you know, that's taken a long time to learn that. And some are easier than others. I think the fact that our cost, the cost to care is so low, that barrier to access is so incredibly low. That in itself helps with our mission on that. That relationship with the doc is extremely powerful. But yes, I mean, we are still trying to figure out ways to get folks to get things done. And some of that is, you know, we do a lot of mobile stuff. So mobile mammograms. We're meeting you at the hotel. Come on out and get your mammogram. Our vision care, that's not a big mover on the dial, but just as an example, our vision care, we're doing mobile. And so we're starting to do a lot more mobile because sometimes getting people to do something, the first step is — just God, if you can be right there at their office and all they have to do is walk out the door, That really lowers the barrier to care.

JOHN: How about, we'll take that a step further though. How about virtual care today? How much of that?

ASHLEY: Yeah, we absolutely do virtual care. We were already doing that before COVID. And so when COVID happened, we were ramped up and ready to roll. And so that helped. And you know, getting to virtual care, I don't know all the specifics behind the scenes, but when we think of how damaging COVID was to the whole world, that's one real cool thing that came out of it. The doors kind of opened on virtual care, you know. So virtual care opened up. We got to wear sneakers to work. So a couple good things going on.

KIM: Picking up on that thread, and I want to talk about this before we run out of time. The Osceola School District. For everyone who says this is, you know, Rosen Hotels only, they're a unicorn. Osceola School District is big. It is messy. It is unions, politics, public scrutiny, the whole deal. I'm really curious to hear you tell us about that and what, quite frankly, nearly killed it and what saved it. Because to me, that's exactly the kind of messy, unfinished, figuring it out kind of energy that we need a lot more of. So yeah, I would love to hear you talk about some of those silver linings and these lessons learned and how they're being applied in really very different environments now from Rosen.

ASHLEY: Well, I think with the school system, I think the status quo did us a big favor. They helped in our effort to get that done. They charged so much. One of the poorest districts in the country could not handle it anymore. And they did not dip their toe in the water. We kind of talked about, you know, dipping their toe in the water. And they said, we are at a stage where we can't, you know, dip our toe in the water. And so, you know, along with that, when you do all of this stuff at once, you know, with a governmental entity or with anyone, there's some bumpiness associated with that. So, you know, we talked about what that bumpiness would look like. And, you know, once you do that, it becomes a little bit easier for the client to digest when the bumps happen. Hey, they talked about the bumps, and here's what we do when we have the bumps. And so that program was bumpy at first, but they've avoided cost in the area of about $100 million so far. And we talked about this is a grassroots effort, right? I think that we made a pretty big splash, and I think they play a pretty big role in helping us change the system and getting other maybe large employers to do that.

KIM: It's really cool to see. And yeah, $100 million in savings is nothing to blink at. I also, I think I heard you just describe, you basically did a pre-mortem, which is what we learn how to do in healthcare, right? Of like, here's how this is gonna go poorly. Let's talk about it before it does. I love that of like, if we're gonna embark on this change, here are some of the really predictable pitfalls, areas of friction. We're gonna talk about that now. And just like you said, so that when they come up, You're like, all right, here it is. Here's the very predictable friction, you know, of these transitions. Any last comment that you want to make on that? Because I am loving hearing the pattern and the replicability in what you're saying.

ASHLEY: You know, I'm just glad that they had the fortitude. You know, they come from, you know, a lineage of cowboys. They take risks. They're tough. And that's what was needed to get this thing done. And they're not falling. they didn't fall into that trap of — Kim. It's almost like a domestic abusive relationship. It's these employers out there that are protecting the very entities that are causing them the most harm. And they're saying next year, you know, I don't think it's going to hurt as much, you know, next year is going to be better. And the school district broke away with that. And like Harris Rosen did and said, we're going to, we're going to do something different.

KIM: Ashley, that's that. I mean, we have landed on that point several times in this podcast of how the status quo feels like an abusive relationship for employers, for patients, for clinicians. And so to hear you land on that same point and that Osceola is an example of breaking away and saying, nope, we're cowboys, we're explorers, we're adventurers. We're going to go try something different because this is not serving us is, again, really heartening.

JOHN: I want to pivot for a minute, Ashley. Tell us, $500 million is a lot of money you guys saved over time. And to Rosen's credit, and you mentioned it a little bit about you love to give back to the community. Tell us about some of the stuff that you've done, not just for your employees, which is incredible, preschool. What have you done for the community? Give us some of those examples, because it's really — everybody should hear this.

ASHLEY: Yeah. So it's interesting, what has allowed us to — has played a large role in us being able to give back is we fixed our health care. We fixed our health care and saved money and got to use that money to fix, you know, other other stuff. And so that's pretty cool. So Harris Rosen adopted the Tangelo Park neighborhood, which is a nearby underserved community near his hotels. And that was, I think, about 30 years ago. Crime ridden, the high school graduation rates, I think in the 50 to 60 percent range. And he told the community that he will pay for their two, three and four year olds daycare, OK, and if he's going to do that, you know, he will be able to mentor them and read to them and that sort of thing. And so when these two and three and four year olds get to kindergarten, OK, they are reading. You know, they are far more developed than people that look like me and my kids who are in a, you know, in a gated community. Crime is non-existent. And, you know, so that's pretty cool. And then if they want to, they can continue to have mentoring through, you know, high school. Some of them need it. Some of them don't. But when they graduate high school, Harris Rosen Foundation pays for their entire college education, you know, room, board, books, tuition, everything. And we noticed years ago that our costs were more and more people were graduating, but our costs weren't increasing. And what we found out was they were getting their own, they were getting their own scholarships and stuff because they didn't, you know, this was becoming more of a safety net. And so, again, you can, you know, if there are two big things that need fixing out there, you know, education and, you know, health care, we kind of, you know, have a template for that.

JOHN: Yeah, that's great. Early childhood education. I have a, my oldest is a principal in elementary school in South Carolina. And, you know, she said something to me once, I'll never forget. She said, you know, dad, you don't really know, but there are a lot of kids who come to school and don't — have never seen a book before they got to kindergarten.

ASHLEY: Yeah.

JOHN: And I'm like, what? And, you know, so that the value of that early childhood education, which of course, you know, I would advocate we should tap across the country, but let's not get down there because that's a political, because political conversation is so critical. Well, that's just a great, just a great thing that your company has been able to do and to give back to the community. Besides all you're giving back, obviously, to your employees, because you can, instead of giving money to guys like me who run hospitals, you can give raises to your employees and invest in your company and expand your business. So God bless you guys. And I could talk to you all day, Ashley Bacot, because you guys are great and pioneers. And we're thinking of this stuff before any of us were. So thank you. Thank you once again for joining us.

LISA: Yeah, thank you. You have certainly impressive approach to delivering health care for your employees. I think, you know, looking — Dr. Schutzer isn't here. He usually asks the futuristic question. So I'm going to take that lead today and ask you, if you had the opportunity to do one thing more today in your plan that would have a material impact for your employees, what would it be?

ASHLEY: I think that we need to somehow instill in the community that, hey, Central Florida, this microcosm we call Central Florida, you know, we're constantly thinking of ways to bring in industry to help us grow and that sort of thing, right? See, we need to have those same kind of thoughts about how we don't allow that community to be fleeced.

LISA: Yes.

ASHLEY: And we need to educate every employer in Orlando on how that's happening. We've got to be careful. We can't be spitting venom. We got to be, we just, I think what we've got to do for the community is instead of saying hospitals suck and they're stealing all our money and blah, blah, blah, blah. I think, I think we just have to get them to buy into our new — we're going to, we're going to have this thing called Uber. Okay. And hey, if taxis can get their stuff together, we'd like to have that too. But, but it's either going to be Uber or the taxis.

JOHN: I have to think it's a huge advantage for your company to be Orlando's big, but relatively local and self contained.

ASHLEY: It's a big advantage. Listen, a lot of advantages. Having that tight area, having a leader like Harris Rosen that says, let's do it. It's a big advantage. Donovan can tell you this. Every employer is different as to how you go about attacking this. But even when you have a very large organization that's spread out all over the place, you may not be able to provide — there are some things for that national employer that the people in the rural areas are just not going to have. And if you say to yourself, well, that's not fair, so I can't do this. Listen, I get that in a silo, but I think, you know, you have to overcome that as a barrier. And for the certain areas, you're going to have a full, robust system. In certain areas, you're going to have something.

JOHN: Yeah, interesting.

ASHLEY: You may not have fully robust, but you're going to have something. And I think that there are a lot of solutions out there for that. One thing that I would like to say, and you all put us on a pedestal, and it's kind, and I appreciate it. And I think 37 years ago, maybe we were some of the smartest people in the room regarding this model. But let me tell you what, I learn from employers that, you know, are a 175 person group who I'm calling to say, hey, what kind of program do you have? And oh, you know, I just started my program with Donovan or something. You know, I just started my program with this advisor and I've got this, this and this. And I'm going back to my medical folks going, hey, I just learned that they have it. We don't have that. So we're learning from others now, too, which is kind of cool.

LISA: We're in the industry and I'm learning something new every day. You know, I think the innovation is so incredibly important. Healthcare is one of the industries where, you know, the innovation on the clinical side is really great, right? And pharmaceuticals, but on the operational and administrative, we're in a dark age as compared to other industries, right? You know, just because of the burden of the regulations and everything else. I mean, just think about how long it took us to put an electronic health record in place, right?

ASHLEY: Right.

LISA: You're kidding me, right? Paper? Until like, what, you know, 15, 20 years ago or something?

ASHLEY: I think the most important thing is getting others, just trying to inspire other employers to do this, I think is critical to changing the face of healthcare in America.

JOHN: Yeah, we would all applaud that for sure. And that's why we're in this enterprise ourselves. I think we all firmly believe that a big part of the solution is for employers to take that ownership and start to look at their — whether it's a moral imperative, a financial imperative. Now it's a legal obligation through the Consolidated Appropriation Act. Employers need to take this on seriously for the betterment of their business, the betterment of their employees, and the betterment of their communities, to your last point. So, Ashley Bacot, thank you so much for being with us today. On behalf of Moving to Value Alliance, thank you. Thank you to the late Harris Rosen for the work you guys, the pioneering work you guys have done. It's been a pleasure having you on today. Thank you.

ASHLEY: Thank you. Thank you for having me.

JOHN: To learn more about MTBA and how to join our community, visit our website, movingtovalue.org. If you enjoyed this conversation, please follow us and leave a review on Spotify or Apple Podcasts. Thanks again for listening and for being part of this important movement.

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