Ensemble Health Partners, which specializes in the management and collection of patient service revenue for Mercy Health-Cincinnati and other hospital systems nationwide, has continued to add clients despite the Covid-19 pandemic’s impact on the health care industry.
And while Ensemble has cut some workforce-related spending and experienced typical turnover, no employees have been furloughed, laid off or had their salaries cut because of Covid, CEO Judson Ivy told me.
In addition, although Ensemble began moving hundreds of employees into its new Blue Ash headquarters on a staggered basis in mid-February, the fast-growing firm quickly adapted to enable all 2,000 employees who were to be based there to work remotely as concerns about the pandemic arose in March.
“The move in was smooth and enjoyable,” Ivy said of the 400,000-square-foot facility on a 54-acre campus. “And then pretty much as soon as we were moving in, we were moving out because of Covid. More important than the move in was our ability to move thousands of people out of Blue Ash to work from home.”
That was accomplished in about nine days, he said, with no connectivity issues or downtime.
“You never anticipate a move out with that speed or fashion – where you can get thousands of people set up and working from home with no productivity drop, no issues with customers,” Ivy said. “I was proud of our team.”
Ensemble serves 380 hospital facilities, which includes all Bon Secours Mercy Health hospitals in Ohio and Kentucky as well as Christ Hospital in Cincinnati, plus more than 6,000 hospital-affiliated providers such as physicians and nurse practitioners.
The firm checks insurance eligibility and submits bills to payers, but Ensemble also ensures medical services are coded properly and fields questions about billing from patients. Ensemble serves clients in 36 states as well as Ireland, and Ivy said the company is in discussions about expanding its services to another country.
About 88% of Ensemble’s employees are working from home because of the pandemic, Ivy said. Some employees continue to work in client hospitals. And about 40 people remain on the job at the Blue Ash headquarters, including security and mail processing.
Ensemble has a total of 5,297 employees spread around the country, up by 13% from 4,670 in November. Another 932 leaseback associates with Bon Secours Mercy Health are supervised by Ensemble on a contract basis.
Last fall, Ivy told me he expected the workforce would grow as Ensemble adds hospital clients.
“Going into Covid, people were unsure whether hospitals would continue to look for partners such as Ensemble, and we didn’t know,” Ivy said. “You saw hospitals struggling for cash flow, volumes were down, they had to lay off their own people, they were naturally pulling back the reins.”
And yet, “we actually signed three new customers during the heat of Covid, which was not what we were expecting but a real testament to our people and our results … and also the market forces putting pressure on health care providers,” Ivy said. “It actually motivated hospitals to say we need to find a partner such as Ensemble that can help us improve our cash flows, that can help us improve our financial standing.”
Both patient volume and revenue were down dramatically at many hospitals from mid-March to mid-May because of state orders to halt lucrative elective surgery in an effort to preserve beds and personal protective equipment in the event of a surge in coronavirus.
“Most of our clients saw a roughly 60% decrease in volume,” Ivy said. Now, “we’re seeing roughly 92% to 95% of the volumes back to pre-Covid baselines, with certain parts of the country ahead and others behind.”
The pandemic’s impact on hospital revenue varied across the country, he said.
In Greater Cincinnati, many hospital systems saw revenue drop by 50%, which prompted furloughs, pay freezes and in some cases the elimination of jobs.
“It’s still very fragile, based on if there’s a resurgence of Covid,” Ivy said of the economic recovery of hospitals.
However, “we took an approach early on that we were not going to furlough and lay off people,” Ivy said of Ensemble. “We didn’t cut salaries.”
While Ensemble froze raises and promotions, the company has committed to implementing wage increases and restoring the firm’s suspended 401(k) match when volumes return.
“We will restore it the minute that we can,” Ivy told me. “This has nothing to do with the financial (shape) of the company. This is about preserving jobs and people’s livelihoods.”
Ivy recently created an employee relief fund with a $100,000 donation, and other senior executives at Ensemble boosted that total to more than $200,000 with their own donations.
“We have probably disbursed about 95% of that,” Ivy said, noting the money has gone to help Ensemble employees whose spouses or other family members were laid off by other companies amid the pandemic.
Ensemble’s employees include 2,076 people in Ohio and 110 in Kentucky. Another 941 workers are based in Tennessee, 764 in Virginia, 320 in North Carolina, 245 in South Carolina and 119 in Arkansas.
Up to 500 jobs are expected to be added in Tennessee over a five-year period so Ensemble can service a new revenue cycle client, Ballad Health, Ivy said. Those employees will work in a new regional operations center in the Appalachian Highlands, which Ensemble will buy or renovate to service clients nationwide.
While Blue Ash will always remain Ensemble’s headquarters, the company had envisioned creating redundancy in its technology operations.
“Covid has actually changed the way we think about disaster planning,” Ivy said. “We used to just contemplate if one building goes down, is the phone system working in the other building? … However, our physical footprint will shrink when we build new things. We won’t be doing 400,000 or 500,000 square-foot buildings.”
Ensemble had about 200 employees in 2016, when it was acquired by Cincinnati-based Bon Secours Mercy Health for $60 million. An additional $40 million in payments was linked to the startup hitting financial incentives, which it did.
In August 2019, Bon Secours Mercy Health completed the sale of 51% of Ensemble to Golden Gate Capital of San Francisco, a private equity firm that reportedly paid $1.2 billion in cash. Bon Secours Mercy Health retains minority ownership.
Ivy founded Ensemble in 2014 in North Carolina but switched the firm’s headquarters to Mason in 2018. The new Blue Ash headquarters, which previously was a Procter & Gamble research and development complex, could accommodate up to 2,600 workers.
The CEO hopes Ensemble employees can come back to work at the new headquarters in the coming months, but he added some previous notions about working remotely have been shattered.
“We have said it’s probably going to be late summer or early fall, but we don’t know – and we’re not going to do anything that endangers our people,” Ivy said. “They are functioning just fine in work from home.
“If we were designing this post-Covid, we still believe it’s super important for people to have a touchdown spot, a place to socialize and build connections, but I don’t know that 100% will all come back,” Ivy said.
He noted some Ensemble employees prefer to work from home because it offers a degree of flexibility and suits their family life.
“So, I think, as a business – and quite frankly as a country – it’s forced us to kind of put to bed some of the old-school thinking that everybody needs to come to the office every day and show up at a certain time to be productive,” Ivy said. “I think it’s taught us new things about that.”
Ensemble always had flexible schedules, meaning employees could come in at 10 a.m. versus 8 a.m. or work in the office on a Wednesday but not a Thursday.