|By Sara K. Clarke, The Orlando Sentinel,
Fla.McClatchy-Tribune Regional News
Oct. 01, 2011--Orlando hotelier Harris Rosen has self-insured his employees' health care for years now, offering them medical care at an on-site clinic where doctors and nurses see patients for $5 co-payments.
Prescriptions are dispensed on site. Office visits are on company time, with free transport to the clinic and back to work. Employees can sign up for free fitness classes or Weight Watchers.
Amid an acrimonious national debate over the direction of the U.S. health-care system, Rosen's company clinic focuses on preventive care in an effort to keep costs low. It's a concept he has begun marketing to other employers through an affiliate called ProvInsure Inc. While there has been some interest in the concept, so far there have been no takers.
Still, Rosen announced plans in August to build a new, 12,000-square-foot health-care center -- triple the size of the existing clinic -- alongside his Quality Inn hotel on International Drive.
"I know it's bold, but I do believe it can change the way the private sector -- and also the public sector -- looks at health care," said Rosen, who thinks his template could save a trillion dollars a year in medical-related costs if replicated nationwide. "You save money, and simultaneously what you're doing is providing compassionate, empathetic care."
About 9 percent of U.S. employers offer their workers some form of on-site medical clinic, according to a survey by the Society for Human Resource Management. That compares with 84 percent who offer conventional health insurance with treatment provided by a preferred-provider organization.
Experts say whether a clinic approach works for an employer depends on several factors, including the company's size, the employee culture, and the program's overall execution.
Rosen has 2,100 employees and 2,200 dependents enrolled at the clinic, and the staff of his seven hotels all work within a 10-minute drive of the medical center.
"Employers typically need a critical mass at a location to justify the cost of putting them [clinics] in," said Eric Parmenter, a vice president at HighRoads, a benefits consultancy in Woburn, Mass. "If you have too few employees, there's not enough return on investment."
Ashley Bacot, president of ProvInsure, estimates that the cost to Rosen for each covered employee (which includes the cost of any dependents) is $6,670 a year. According to the Society for Human Resource Management, the average annual cost in the U.S. for employer-provided health care is $9,531 for each covered employee.
Rosen calculates the savings another way: He figures his plan allows him to insure one "covered life," be it an employee's or a dependent's, for about $2,900 a year. He contrasts that with the country's per-capita spending on health care overall, which amounted to more than $7,900 in 2009, according to data from the Organisation for Economic Co-operation and Development. Those are the figures he uses to generate the trillion-dollar savings if his approach were to be adopted nationwide.
To keep costs low, Rosen's company keeps doctors and nurses on salary in its clinic rather than paying per-visit fees. It handles its own prescriptions, avoiding pharmacies' drug-dispensing fees. Patient visits occur during work hours, which encourages employees to deal with minor health issues before they become expensive, corporate liabilities. For non-routine care, the company negotiates with local hospitals and has relationships with various medical specialists.
"Once somebody comes into our insurance, we're calling that person ... so we can start the prevention process," said Kenneth Aldridge, the medical center's director. The reasoning, he said, is simple: "If they're healthy, we don't pay it on the other side."
Some of the company's tactics are less conventional. It has a no-smoking policy, for example, and employee drug tests can detect the presence of nicotine -- an offense that can lead to counseling or even termination. The clinic also aims to get its patients out of the hospital as soon as it is deemed safe, preferring instead to pay for at-home care.
"Cost aside, what has been created over the last 20 years here, I think -- philosophically, culturally -- makes a lot of sense," Rosen said. "What we've done, at the very least, is we've moved the spotlight from, 'Don't worry if you get sick' ... [to] ... 'We'll do everything to keep you well.' "
Scott Smith, a lodging instructor in the University of Central Florida hospitality school that bears Rosen's name, recalls getting his medical care at the clinic back when he worked for the hotel company's sales department.
"It was almost like the old country doctor," Smith said. "She knew all of her patients, had kind of a personal rapport with them."
And from the employer's perspective, Smith said, the program helps the company retain workers.
"If I can offer my people quality health care, and they don't have to worry about all of the bells and whistles and hoops that people have to jump through with other health-care programs, than that's going to be what we call in the industry a 'satisfier,' " Smith said. "Satisfiers reduce turnover, [and] the cost of turnover is incredible these days."
But while Rosen is reporting lower costs, Parmenter said the limited research available regarding on-site clinics generally "has not been overwhelmingly positive" in terms of saving money.
Also, on-site clinics don't work well in a combative work environment, where employees might be suspicious about the quality of the care their employer has arranged for them, he said.
"I think there's that mistrust factor that can occur between employees and employer," Parmenter said. "If you're going to offer an on-site medical clinic, you probably need to have a positive working environment with high employee engagement."
Rosen's reputation for fostering employee loyalty is well-known; he has generated goodwill among his workers through the years with philanthropic investments in the local community and in Haiti, the native country of many of his employees.
While the rest of the medical industry continues to struggle with the costs of lawsuits and other liability issues, Rosen said his company's clinic has never been sued in its 20-year history -- and he's not surprised.
"Why should we be? We're trying our best," he said.
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