Abstract
This paper provides some community-based creative solutions bridging Hospitality to Healthcare – putting the “heart back in healthcare” to improve the health and well-being of the community. These innovative programs provide a blueprint for high performance and practical health benefits. These programs cover a wide array of tactics that are practical fixes for health care systems. The health models presented in this paper are adaptable to other geographical regions and are brilliant beacons for health that can succeed and impact other communities.
The healthcare enigma: “Starbucks spends more on healthcare than on coffee beans” and General Motors (GM) is a health benefits company with an auto company attached (Warren Buffet).
Introduction
Healthcare is the second largest expense for most companies, following payroll. If we cannot slay the healthcare “beast,” millennials will have their future stolen from them (David Chase, 2020 in Relocalizing Health: The Future of Healthcare is Local). Millennials are now the largest portion of the workforce and, by 2025, will represent 75 %. On its current trajectory, healthcare will see millennials spend half to two-thirds of their lifetime earnings on healthcare! Healthcare costs are stealing Millennials’ future, and they will fight to take it back. Millennials are or will become more cognizant of the fact that only 20% of their health outcomes are the result of clinical medical care. The other 80% of health care spending is under their control for health and well-being, such as diet, exercise, tobacco use, alcohol, drug use, genetics, air and water quality, education, employment, housing, etc. are more local and impacted by community-centered health and well-being programming. What will follow are examples of community-based innovative models of health and medical programs such as RosenCare and Northwest Colorado Health which are models for health that have an impact and can be replicated in other US communities.
Current State of Healthcare
A point of fact is that in healthcare, most citizens in the communities they live and receive their clinical care, only about $0.27 of each dollar spent remains in local hands, and about 75% of each dollar goes to health corporations, drug/pharmaceutical, and health insurance plans with corporate headquarters in other states. Dollars are siphoned off elsewhere instead of remaining in the local communities where these taxpaying citizens work, study, and live. If these dollars were not extracted elsewhere, they could go to local health and well-being (defined as body, mind, and spirit), which have positive outcomes for better health of the children and adults living locally.
Local communities are burdened with burgeoning high healthcare costs, feeding distant, out-of-town bureaucratic corporations that are not sustainable. Instead, as you will read, Rosen Hotels Orlando is a powerful model of healthcare for their employees and can help transform the Orlando, Florida, communities by reinvesting money that would have otherwise been squandered on huge out-of-town profit-motivated corporations (Chase, D.,2020). There buying (Healthcare) locally can reinvigorate communities. In the RosenCare model for Rosen Hotel employees, a transformation took place with high school graduations up, communities energized, and drug and crime down by keeping the healthcare dollars locally and having extraordinary beneficial impacts. With Millennials now the largest percentage of the workforce and 75% by 2025, community change is sure to follow for this cohort where health, fitness, food, nutrition, and well-being are at the core of their lives.
What is forcing innovation in US healthcare?
There is a multitude of problems and challenges with the US healthcare system. Commonly used words to describe it include ‘dysfunctional,’ ‘inequitable,’ ‘controlled by myopic traditional business practices and values,’ ‘full of inbred greed,’ and ‘fiscally and financially out of control.’
The US spends over US $4 trillion per annum (approximately 18% of GDP) on its healthcare system (Chase, 2017). These healthcare costs have nearly doubled in the ten years between 1999 and 2009. Families’ spending on healthcare has increased 25% since 2007, while at the same time, other spending on basic needs such as clothing, housing, transportation, and food at home and away has decreased (Wall Street Journal, 2016).
Research has identified several reasons for this inefficiency, including:
- Lack of accountability. Data shows that clinicians are not held accountable for their quality of care, with a misdiagnosis rate of 20-40% (Chase, 2017).
- The strength of lobbying by the healthcare and pharmaceutical industries, looking to protect the status quo and influence healthcare and insurance policies for their benefit.
- The domestic belief that American healthcare is the ‘gold standard.’ In fact, US healthcare is twice as expensive as, and delivers significantly worse results than, those of many other countries (Chase, 2017).
- There exist in the US widespread conflicts of interest among benefit managers of business firms (insuring their employees) who hire benefit consultants, who are paid by health insurers and providers.
A recent article in the Wall Street Journal found nonprofits, which get tax breaks for their charitable work, throw up hurdles for the needy. Nonprofit hospitals must have financial-assistance policies for needy patients, under federal requirements tied to an estimated $60 billion in annual tax breaks. They often make that aid hard to get. In fact, many hospitals put up obstacles, delay checking eligibility, and sometimes press for payments that are not refunded even if a patient eventually gets qualified for assistance ( Anna Wilde Mathews, Andrea Fuller, and Melanie Evans, 2022).That is according to a Wall Street Journal analysis of thousands of nonprofit hospital policies in filings to the In-ternal Revenue Service and posted by hospitals
Another concern is that risk-averse human resources executives and CEOs will pay significant healthcare insurance premiums to keep employees happy and avoid lawsuits. Furthermore, out of concern for employee well-being, some American entrepreneurs have looked to build alternative cost-saving healthcare systems, born out of evidence, quality outcomes, transparency, compassion, and accountability.
A Strategy That Could Fix Healthcare
For healthcare, the days of business as usual are over. Around the globe, healthcare systems are being staggered with rising costs and uneven quality of patient care. It is time for new strategies and tactics to counter broken healthcare models. Michael Porter and Thomas Lee, in On Strategy for Healthcare (Harvard Business Review, 2018), state that we must move away from a supply-driven healthcare system around what physicians do, toward what patients need (“Patient-centric Care”). Thereby shifting away from (patient) volume and profitability and providing service – to positive patient outcomes achieved. Replacing todays often fragmented medical delivery in which every local provider offers a full menu of medical services and medical conditions are concentrated in health delivery organizations to the optimal right locations (preferably local) to deliver high-value care (Porter and Lee, 2018).
RosenCare® Revolutionary Employee Healthcare Approach: Community Renaissance
“A hotel company has the best benefits package of any employer I have ever seen -and they spend 55 % less than employers of comparable size. In addition to providing quality, affordable healthcare to employees and their families, they invested a fraction of what they saved in into the local Orlando, Florida communities and school system, which are seeing stunning results: crime down by 67 % and high school graduation rates have doubled to essentially 100 %. It is happening in Orlando right now “(Chase, D.,2020).
Introduction to some Innovative Community Based Health Initiatives
An innovative, self-insured employee healthcare model developed by Harris Rosen, the founder of Rosen Hotels & Resorts in Orlando, Florida, has the potential to revolutionize medical care. Harris Rosen, Central Florida’s largest independent hotelier, is widely recognized as an entrepreneur and passionate philanthropist. He also founded RosenCare®, a self-insured healthcare model that has already saved the company US$340 million. These savings have been channeled into employee education, improvements in the dedicated medical center, and various philanthropic projects, which have had a significant beneficial ripple effect far beyond the Rosen hotel sites in Orlando, Florida.
Harris Rosen is the founder, COO, and President of Rosen Hotels & Resorts. He heard what PwC data showed; half of health care spending does not add value. He assembled a team of talented managers and tackled this healthcare challenge. Rosen Hotels have saved over $315 million on health care costs since 1971 and is spending less than 50 % less per employee than the average employer. RosenCare has gone from five hundred employees to nearly 6,000 employees and family members. The single employee coverage cost is roughly $30 per week for health benefits, which include dental and pharmacy.
The RosenCare® success has attracted the attention of members of the US Congress, the US Army, and business executives, and several large companies, including Disney, have created similar programs.
A research paper assessing the RosenCare® model concludes that it is a viable model that other similar businesses could adopt. If the entire US public and private sector accepted this approach, they suggest there could be an annual savings of approximately US$935 billion simply by preventing unnecessary illnesses and diseases and by emphasizing the importance of a healthy lifestyle (F. DeMicco and A. Pizam, 2019).
Wider adoption of this model has the potential to drive down medical service prices in the US, making the country’s healthcare industry more competitive. We look at some of the paper’s key findings.
The RosenCare® Story
Rosen Hotels & Resorts is the largest independent hotel operator in Central Florida. In 1991, it started operating its own primary care health facility and service (RosenCare®) for its associates and dependents. It is, according to the company, “a patient-centered onsite medical home model” based on five tenets: access, quality, service, cost, and innovation.
Key features of the company’s health offering include A 12,000-square-foot medical center for employees and their dependents to access routine healthcare services. It is equipped with used but functionally modern medical equipment, purchased for a much lower cost than new equipment (Chase, 2017).
The center has a current staff of four full-time physicians, one part-time physician, three nurse practitioners, two physician assistants, and support staff who see and treat between 160 and 180 patients a day.
Same-day appointments are available, and transportation to the center is free. Doctor visits are on company time, so no one loses pay. Each center pays special attention to the management of chronic health conditions, with particular emphasis on preventative health and wellness. There are free health screenings for diabetes, breast cancer, colon cancer, sexually transmitted diseases, and high blood pressure. A registered dietitian is also available. As a result, the medication compliance rate for Rosen associates is over 92% for cardiovascular medications (including hypertension) and 96% for diabetes, compared to national averages of 46 and 50 percent, respectively.
Out-of-pocket costs to Rosen’s covered employees are minimal. The most they pay for a prescription, for example, is US$30, and most of the time prescription drugs are free. Wellness check-ups have a zero-dollar co-pay, and co-pays for specialists are US$20.
RosenCare® premiums include dental coverage for US$16.17 per week for the majority of individual associates and US$53.05 per week for the majority of families.
Rosen company events serve food approved by nutritionists, and the dining area gives discounts on healthier food. The company also provides cooking and exercise classes.
Rosen Hotels has zero-tolerance for tobacco use and conducts random drug tests for its employees. It also has a mandatory stretching program for housekeeping staff and other employees who may have a higher propensity to musculoskeletal problems. These injuries were reduced by 25%.
Rosen’s healthcare costs are about 40% less than the national average on a per-capita basis. In 2018, RosenCare’s cost per covered life was approximately US$5,500 for its 5,700 employees. In the same year, the national average per covered life was over US$11,000. In the hotel industry, annual employee turnover is approximately 60%, but at Rosen Hotels & Resorts, it is in the low teens. And with high school graduations at around 100 % at a Rosen adopted Tangelo Park community, college incentives from Rosen translate to around an 80 % graduation rate above the national average. In addition to Tangelo Park, Rosen Hotels has agreed to adopt another community in the Orlando area, called Parramore, which is about five times the size of Tangelo Park. The mantra for Harris Rosen is: Get involved; and care about your people (adapted from Chase, D., 2020).
Based on its success, Harris Rosen has recently started a consulting company that will advise private and public sector organizations on how to set up programs similar to RosenCare®. He also wants to develop alternative approaches to other aspects of healthcare, including providing a fixed cost price in hospitals for all medical services associated with a particular diagnosis (e.g., bariatric surgery).
Rosen care focuses on the management of chronic conditions and has seen a drop in new chronic disease development. RosenCare and hotels are partnering with other businesses in the community to spread health wealth. This community ripple effect expands into the broader economy, and employee turnover rates in the hotel industry can approach 100 %, and Rosen Hotels has an employee turnover rate in the low teens. Rosen care focuses on the management of chronic conditions and have seen a drop in new chronic disease development. Rosen care and hotels are partnering with other businesses in the community to spread the health wealth. This community ripple effect expands into the broader economy, and employee turnover rates in the hotel industry can approach 100 % and Rosen Hotels has an employee turnover rate in the low teens.
It is also possible that either Harris Rosen or some other hotel owners will eventually decide to extend the RosenCare® model to their onsite guests, especially for non-complex or selective treatments. At present, the majority of US healthcare organizations provide healthcare services to their own employees through insurance companies that have specific programs tailor-made to the healthcare industry. If the RosenCare® model is adopted in hospital groups, these organizations will incur significant employee healthcare savings that can be used to reduce the fees for medical services.
Northwest Colorado Health: Another Innovative Community-Based Healthcare Model
Overview, History, Need
At Northwest Colorado Health, they believe that everyone deserves the chance to achieve their best health. Every day, Northwest Colorado Health partners with individuals throughout Northwest Colorado at their homes, in our clinics, and in the community because healthy people and families create a healthy community. Northwest Colorado Health was founded in Steamboat Springs, Colorado in 1964 in collaboration with Routt County. What started out as a small agency providing only public health and home health has grown to provide primary, dental, and behavioral health care, hospice, home health, and wellness and prevention services to all members of our community. Since 2006, they have acquired The Haven Assisted Living, and opened two Federally Qualified Health Centers. Additionally, they operate two dental clinics in Craig and Oak Creek and school-based dental clinics in Hayden and Steamboat Springs. Since 1964, Northwest Colorado Health has worked to understand and address the needs of our community.
Due to the remote and extremely spread-out nature of the region, many residents are employed in a different town than they live. It snows consistently for at least 6 months of the year where two lane, mountainous winding roads connect small towns, and resources can be dispersed or unavailable. The rural and frontier setting results in lack of public transportation, increased no-show rates, reduced incomes, a higher rate of uninsured individuals, limited access to care, and limited providers accepting Medicaid. These realities make access to affordable healthcare a regional and community priority.
Additionally, the region faces disparities created by the juxtaposition of resort and rural. Often times, those working to support the resort industry’s restaurants and hotels, build and clean luxury homes, are unable to afford housing, or health care, often living below the area’s self-sufficiency incomes and far from the resort lifestyle relying on them for success.
Organizations like Northwest Colorado Health are essential to addressing disparities driven by the social determinants of health. As a safety net health care provider, Northwest Colorado Health actively works to serve all individuals regardless of their income, race, age, gender, health status, or insurance coverage because everyone deserves the chance to be healthy and well. No one should be denied the opportunity to see a doctor, receive healthcare, or participate in preventive health programs. Currently, 31% of our patients in the Community Health Centers are enrolled in Medicaid, 14% in Medicare, 32% are uninsured, 23% have private insurance, and our clinics provide access to all individuals, regardless of their ability to pay.
Health Equity
Over the past few years, Northwest Colorado Health has increasingly engaged in health equity work and are currently undergoing an intensive initiative through the Institute for Healthcare Improvement to assess and continue working on health equity in all areas of our work. The initiative involves developing a Culture of Equity plan, which will include action steps such as staff education around Health Equity, implicit bias training, cultural competency, an equity dictionary, cultural goals, hiring practices, and other best practices. Northwest Colorado Health will work clarifying and communicating the connection between our mission and health equity, advocacy efforts, and external communications. Northwest Colorado Health also has a team examining and assessing access to healthcare through coverage and the racial inequities creating barriers to accessing care in our community. This work will benefit all of our patients, programs, and our organization as a whole. We will adhere to the following framework to develop this work and goals:
Values:
- Access to health is everyone’s right
Regardless of their income, race, age, gender, health status, or insurance coverage, everyone deserves the chance to be healthy and well. No one should be denied the opportunity to see a doctor, receive healthcare, or participate in preventive health programs.
Northwest Colorado Health Focus:
- We focus on health, not just healthcare
Health and wellbeing are at the heart of everything we do at Northwest Colorado Health. Through our proactive, preventive programs and services, we strive to help people stay healthy and well. While we do treat illness and injury, our goal is for every member of our community to be empowered with the information, tools, and resources they need to live a healthy life.
- Compassionate, personalized care improves outcomes
How we deliver healthcare makes a difference to our patients and their health results. We treat everyone with compassion, integrity, and the utmost respect. We take the time to really understand every patient’s situation and never pass judgment. By meeting patients where they are with kindness and empathy, we serve as their partners on their health journey.
- We deliver only the highest quality programs and services
We take extraordinary pride in providing the most advanced and effective programs and services. We hold ourselves to the highest standards to ensure our patients receive exceptional care. As a non-profit organization, we always focus on providing what is best for each patient rather than what makes the most money.
Every day, we strive to model the healthy behaviors we promote to our patients. From eating well and exercising to preventative screenings and regular check-ups, we practice what we preach.
Mission
Improve the quality of life for all Northwest Colorado residents by providing comprehensive health resources and creating an environment that supports community wellness.
More website info on Mission and the Annual Report can be found: https://northwestcoloradohealth.org/who_we_are/our-mission.html
Impact
The Impacts of Northwest Colorado Health cover a wide depth and breadth, with the largest being increased access to care. When barriers are removed, and people can access medical, dental, behavioral, and preventative health, it helps with access to other needs such as housing, education, food, and employment. We provide comprehensive services to those in need, from birth to end of life, regardless of ability to pay, serving roughly 15,000, or 30% of our regional population each year. We provide services in Northwest Colorado, an area making up 11,954 square miles of the state (roughly the size of Delaware, Rhode Island, and New Jersey combined). These are rural, geographically isolated areas with many parts federally designated as a Health Professional Shortage Area and a Medically Underserved Area/Population. These realities make access to affordable healthcare a regional and community priority. Additionally, our annual program impacts include:
- Serving youth through over 4,514 encounters in the Youth Resiliency Program, preformed 984 cardiovascular screenings and follow up sessions, and served 335 individuals in our Aging Well program with offerings such as fitness classes, Foot Care Clinics, and Senior Wellness Clinics. We provided support to women and families including 1893 WIC nutrition education sessions, and 784 SafeCare visits.
- Serving 263 homebound patients in three counties through our Home Health programs.
- Provided Hospice care to seventy-two people.
- Provided to 6149 patients, including 4,679 medical, 2,080 dental and 1,295 behavioral health patients over 22,430 encounters.
- Served thirty-one individuals at The Haven Assisted Living.
ROI
The return on investment in community health is well documented. Health center expansion lowers utilization of emergency room visits where health centers are present1. According to the National Association of Community Health Centers, Health centers meet or exceed nationally accepted practice standards for the treatment of chronic conditions. In fact, the Institute of Medicine and the Government Accountability Office have recognized health centers as models for screening, diagnosing, and managing chronic conditions such as diabetes, cardiovascular disease, asthma, depression, cancer, and HIV2. Health centers’ efforts have led to improved health outcomes for their patients, as well as lowered the cost of treating patients with chronic illness3.
Conclusion
This paper has provided some community-based solutions to improve the health and well-being of its citizens. These innovative programs can be created and offered to hospitality employees and their families and provide benefits of employee commitment, lower turnover, and positive cultural environment to these operations.
These are innovative programs from RosenCare to Northwest Colorado Health. Another good model to follow is an eco-systems approach called Health Rosetta.Org, a blueprint for high performance and practical health benefits. It covers a wide array of tactics that are practical fixes for health care systems.
Exemplary examples of community-based health and medical programming such as RosenCare and Northwest Colorado Health, are Innovative healthcare delivery systems which are patient centric serving and improving their respective communities. These health models are adaptable to other geographical regions and are creative beacons for health that have success and impact and reproducible to other communities across the United States.
Acknowledgment: This Paper is sponsored by the GloMed.Education website https://glomed.education/.
References
- David Chase, 2020 in Relocalizing Health: The Future of Healthcare is Local. https://www.amazon.com/Relocalizing-Health-Future-Local-Independent/dp/0999234366
- Chin M. (2010) “Quality Improvement Implementation and Disparities: The Case of the Health Disparities Collaboratives.” Medical Care, 48(80):668-75
- Cunningham P. (2006) “What Accounts for Differences in the Use of Hospital Emergency Departments Across U.S. Communities?” Health Affairs 25: W324-W336.
- Frederick J. DeMicco, Ph.D. and Abe Pizam, Ph.D. RosenCare® Revolutionary Employee Healthcare Approach Could Boost Medical Travel to the USA Hotel Online | January 31, 2019 https://www.hotel-online.com/press_releases/release/rosencare-revolutionary-employee-healthcare-approach-could-boost-medical/
- Rust George, et al. (2009) “Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties.” Journal of Rural Health 25(1):8-16.
- Anna Wilde Mathews, Andrea Fuller, and Melanie Evans (2022). Hospitals
Skimp On Aid. The Wall Street Journal. November 2022, p 1. - Institute of Medicine. (2003) Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. National Academy of Sciences Press. U.S. General Accounting Office. (2003) Health Care: Approaches to Address Racial and Ethnic Disparities. Publication NO GAO-03-862R.
1. Rust George, et al. (2009) “Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties.” Journal of Rural Health 25(1):8-16. Cunningham P. (2006) “What Accounts for Differences in the Use of Hospital Emergency Departments Across U.S. Communities?” Health Affairs 25: W324-W336.
2. Institute of Medicine. (2003) Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. National Academy of Sciences Press. U.S. General Accounting Office. (2003) Health Care: Approaches to Address Racial and Ethnic Disparities. Publication NO GAO-03-862R.
3. Chin M. (2010) “Quality Improvement Implementation and Disparities: The Case of the Health Disparities Collaboratives.” Medical Care, 48(80):668-75
Fred DeMicco
Northern Arizona University
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