Ashtabula County, Ohio. One of the poorest counties in the state. A medical desert. One primary care doctor for every 3,500 residents against a national average of one per 1,300. At least 30,000 people living in medical debt. And $1.4 billion flowing through that county every year, with at least $450 million of it being extracted out to distant corporations.

This is the story of what happened when a benefits advisor named Bryce Heimbach, a concierge nurse navigator named Casey Billington, a direct primary care physician named Dr. Brad Schneider, and a pharmacist named Maria Fowler decided to stop accepting that as inevitable.

It started with a school district. Ashtabula Area Schools, the 8th poorest district in Ohio, was spending more than 20 percent of its general fund on healthcare. In July 2020, they put in a new plan. By May 2021, less than a year later, a school levy failed that would have meant teacher layoffs, cut programs, and gutted transportation. Except it did not matter because in less than a year, the plan had already saved $2.4 million, more than the entire levy would have raised.

The story did not stay in the school district. A teacher married the city manager. The city of Ashtabula tried it. Saved $360,000 in year one. The county followed. Private employers followed. Crystal Clinic, the number one surgical facility in Ohio, started getting so much volume from Ashtabula members driving an hour or two for zero cost share that they opened a clinic right in the county.

A medical desert started getting its doctors back.

A police detective's daughter broke her ankle out of town. He called the concierge nurse. By the time he was on the interstate, everything was handled. A teacher named Maureen Cerbella stopped paying for her life-saving medications. She said it felt like a $3,000 raise.

And a funeral home director named Mike Chupp, who had spent his career noticing that every fourth body he prepared had not even reached his own age, started seeing something different in his community.

Bryce Heimbach is at RosettaFest 2026 in Nashville, July 29 to 31. He will be in the room.

Key Takeaways:

• Ashtabula County is one of the poorest counties in Ohio with one primary care doctor for every 3,500 residents and at least $450 million extracted annually to distant corporations
• Bryce Heimbach joined Health Rosetta in 2018 at the very first gathering in Chicago after nearly leaving the industry
• The football team metaphor: nurse navigators are the fullbacks, primary care is the running back, and what wins is constant communication and alignment across the team
• Casey Billington co-founded Concierge Nurse Navigators bringing oncology-style navigation to the broader population for the first time
• Dr. Brad Schneider left a hospital where he was seeing 30 patients a day in 15-minute visits and drove 45 minutes each way to practice medicine the way he was trained
• Maria Fowler at Hoffman's Pharmacy, one of the last independent pharmacies standing, became the preferred pharmacy with generic medications free for members
• Ashtabula Area Schools, the 8th poorest district in Ohio, saved $2.4 million in less than a year, more than an entire school levy
• The city of Ashtabula saved $360,000 in year one
• The dominant regional hospital system pushed back hard on price transparency, which Bryce said was proof they were over the target
• Unions became the strongest advocates after asking: you're telling me this can be free and you'll validate the physicians are highest quality? Yes
• Crystal Clinic, the number one surgical facility in Ohio, opened a clinic in Ashtabula County after receiving so much volume from cooperative members
• Bryce and partner Frank Stichter took the model west and helped launch a community-owned health plan on the Western Slope in Colorado
• The model works in the 8th poorest county in Ohio with a single hospital town. The excuse that anyone else cannot do it is wearing thin.

Resources Mentioned:

• Relocalizing Health by Dave Chase: pre-order on Amazon now
• RosettaFest 2026: RosettaFest.org — Bryce Heimbach is part of the Employer Track
• Health Rosetta: healthrosetta.org
• Nautilus Health Institute: open-source tools and frameworks

Learn More:

RosettaFest 2026 - https://rosettafest.org/

Health Rosetta - http://healthrosetta.org/

Nautilus - https://www.nautilushealth.org/

Kynexions - https://kynexions.com/ 

Dave Chase - https://www.linkedin.com/in/chasedave/

Podcast Website - https://relocalizinghealth.com/