Relocalizing Health with Dave Chase

Welcome back to Relocalizing Health. In this episode, host Dave Chase sits down with Charles Marohn, founder of Strong Towns and renowned author, to explore what it truly means for a town to be "strong." Drawing analogies from the built environment and decades of on-the-ground civic work, Chuck shares how robust communities rely not just on fiscal sustainability or infrastructure, but on engaged citizens who are empowered to solve problems collaboratively. Together, they dive into stories of transformation in places like Ashtabula County, Ohio, discuss the cultural and mindset shifts necessary for local change, and outline practical frameworks for making meaningful progress, one small step at a time. Whether you’re a civic leader, public sector employee, or just someone who cares deeply about your community's well-being, this episode will leave you inspired and ready to roll up your sleeves to co-create healthier, more resilient places.

Timestamps:

00:00 Defining sustainable city development

04:41 Struggling Ohio school district finances

08:46 Using relatable examples for change

10:33 Engaging the local community

15:21 Rethinking public investment strategies

17:29 Businesslike approach to running cities

22:48 Implementing community development projects

26:16 Southcentral Foundation's healthcare transformation

29:49 City council meeting dynamics

30:32 Creating an equal meeting environment

36:40 Importance of community dialogue

38:02 Wrapping up healthcare insights

Ashtabula story:

Short version - https://relocalizinghealth.com/episode/case-study-the-poorest-county-in-ohio-kept-450-million-home-and-changed-everything

Full Conversation with Bryce Heinbaugh - https://relocalizinghealth.com/episode/how-community-owned-health-plans-are-transforming-healthcare-and-boosting-local-economies

Full Conversation with Dr. Brad Schneider, Maria Fowler, and Casey Billington - https://relocalizinghealth.com/episode/how-ashtabula-county-reclaimed-healthcare-direct-care-and-community-plans-beat-corporate-systems

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/

Welcome to another episode of Relocalizing Health. Today, we explore how something as simple as rethinking medical imaging can spark a transformation in employer-sponsored healthcare, creating real wins for employees, employers, and communities alike. Host Dave Chase is joined by Dr. Cristin A. Dickerson, a radiologist and founder of Green Imaging, whose innovative approach has brought bundled transparent pricing to imaging services in thousands of communities across America.

Together, they discuss why imaging is often the first and most powerful step for organizations seeking to take control of their healthcare spending, breaking down the barriers that have long frustrated patients, from lengthy authorizations to surprise bills. You’ll hear real-world stories of school districts, cities, and counties that have saved millions, improved employee access to care, and even turned health plan savings into raises for their staff.

Dr. Cristin A. Dickerson shares how building trust, local partnerships, and simple processes can empower even the most change-averse organizations to take meaningful action. If you’ve ever wondered how health plan innovation really happens or what it takes to move from frustration to affordable, accessible care, this episode is for you.

Timestamps:

00:00 Decision-making in public health plans

05:26 Imaging as a crucial first step

06:56 Partnering with Imaging Centers

13:11 Barriers to accessing healthcare

15:49 Getting Brevard County's Approval

17:11 Improving radiology authorization process

22:45 Changing Health Plans Off-Cycle

25:31 Targeting healthcare decision-making

29:39 Hospital billing and negotiation challenges

31:57 Credit unions and hospital practices

36:22 Discussing the Health Reset Dividend

38:47 Affordable healthcare access benefits

41:18 Closing and sign-off

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/

Welcome to Relocalizing Health. In this episode, Dave Chase explores the powerful connection between neighborhood cohesion and health with guest Seth Kaplan, author of Fragile Neighborhoods. Over recent decades, American communities have suffered from declining local relationships, and with no meaningful incentive to make neighborhoods better, both public and private institutions have unintentionally worked in silos, often leaving health outcomes and the social fabric itself worse off.

But there's a movement underway. Across the globe, from Singapore to the Netherlands, new models of healthcare have emerged, focused on empowering residents and rebuilding care around neighborhoods rather than institutions. Drawing on case studies and lessons from around the world, Seth Kaplan and Dave Chase discuss how shifting our mindset, restructuring incentives, and revitalizing neighborhood governance could radically improve health, reduce costs, and revive a sense of belonging.

Join us as we explore what happens when the neighborhood, not just the individual, becomes the patient, and how each of us can spark change, starting right where we live.

Timestamps:

00:00 Community-driven healthcare models

04:46 Exploring American social cohesion

07:55 Flaws in the American healthcare system

12:50 Yishun Health community engagement strategy

16:55 Creating community healthcare nodes

20:08 Fostering Health in Communities

22:55 Community and Charity Involvement

26:39 Growing small health plans into communities

31:50 Sovereignty and healthcare systems

33:07 Rural electrification and community action

36:31 Neighborhood-centered governance ideas

40:10 Neighborhood improvement incentives

45:01 Public sector's role in healthcare

47:02 Importance of social relationships

53:01 Rethinking and nurturing new ideas

54:39 Community-led healthcare initiatives

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/

Welcome to Relocalizing Health, where we explore the transformative power of community-driven healthcare reforms. In today’s episode, guest Lee Lewis and host Dave Chase challenge long-held beliefs about healthcare being an uncontrollable cost and reveal how employers, by banding together in cooperatives, are not just cutting expenses but improving care quality and outcomes.

Drawing inspiration from the historic rise of rural electric cooperatives, Dave Chase introduces us to the Health Transformation Alliance, a pioneering employer-owned cooperative reshaping health benefits for millions. Lee Lewis, Chief Strategy Officer of the Health Transformation Alliance (HTA), shares behind-the-scenes stories and actionable insights on how organizations can pool resources, break industry dogmas, and unleash innovations that empower individuals and whole communities.

Tune in to hear inspiring case studies, practical strategies for change management, and a powerful call to action for every employer, community leader, and clinician ready to take back control of healthcare and make a real difference for the people they serve.

Timestamps:

00:00 Building a healthcare co-op

03:39 Saving for Employee Nursing Stations

08:35 Misconceptions about saving on healthcare

10:25 Identifying motivated benefits team members

15:23 Highlighting hospital cost and risk issues

19:03 Collaborating with local employers

20:42 Scaling innovation with initial partnerships

26:03 Improving patient care navigation

29:39 Improving employee benefits and savings

31:55 Economic impact of technology in workplaces

34:40 Healthcare crisis and hero benefits leaders

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/

This episode is for the person who has been following this series and wants to know what is actually inside Relocalizing Health before they read it, and what they will walk away able to do differently.

Dave Chase addresses three specific audiences directly.

For advisors: the book is a field manual for building fiduciary-grade plans that hold up under scrutiny. It covers the contractual language that separates a plan built to perform from one built to produce revenue for intermediaries, the data access requirements that give employers genuine visibility into how their money is being spent, and the selection and evaluation frameworks that let advisors build accountability into every vendor relationship.

For employers: the book shows what it looks like when a health plan is treated as a line of business an organization is actually willing to manage. Not a cost center that absorbs annual increases and passes them to employees. A strategic asset that generates a real dividend and reinvests it in the workforce.

For community leaders: the book makes the case that healthcare cost is an economic development problem with a documented solution. The communities that get this right do not just save money. They redirect those savings into schools, workforce development, housing, and the kinds of local investments that build durable economies.

Dave also addresses the AI Catalyst section specifically: as artificial intelligence displaces workers at scale, the communities that have figured out how to generate and redirect healthcare savings will have the resources to invest in workforce transition. The ones that have not will face a compounding crisis.

The book launches July 29. Every attendee at RosettaFest gets a copy.

Key Takeaways:

• The book is written for three distinct audiences with three distinct entry points: advisors, employers, and community leaders
• For advisors: fiduciary-grade plan building, contractual language, data access requirements, vendor evaluation frameworks
• For employers: treating the health plan as a strategic asset that generates and reinvests a real dividend, not a cost center absorbing increases
• For community leaders: healthcare cost is an economic development problem with a documented solution and the communities that solve it build durable economies
• The AI Catalyst section: communities that redirect healthcare savings into workforce development will have resources for the transition that AI displacement is accelerating
• The Nautilus Health Institute has democratized the tools so this is no longer locked behind expensive consultants or proprietary frameworks
• The book is a field manual, not a manifesto. The playbook exists. What is left is the will to use it.

Resources Mentioned:

• Relocalizing Health by Dave Chase: pre-order on Amazon now
• RosettaFest 2026: RosettaFest.org
• 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/

This episode walks through the Rosie Award winners and the case studies that make up the appendix of Relocalizing Health — the documented proof that the model described in this book is not theoretical.

Dave Chase walks through what the Rosie Awards actually represent: employers and public sector organizations evaluated on real Plan Grader scores and real reinvestment of savings through the Health Rosetta Dividend. The awards are not given for good intentions. They are given for results, for documented outcomes that show up in the numbers.

The episode covers the kinds of results that have earned organizations a place in the appendix and on the Rosie Award stage: school districts that saved millions and kept teachers in classrooms, municipalities that redirected healthcare savings into community infrastructure, employers that eliminated deductibles and copays while reducing total cost, and health systems that demonstrated what direct contracting with employers actually looks like in practice.

Dave is direct about why these stories matter: because the standard objection to everything in this book is that it sounds good in theory but would never work at scale or in a normal organization. The appendix is the answer to that objection. These are normal organizations. They are not wealthy. They are not in major metropolitan areas. Many of them are in the same kinds of communities that have been told this is too hard, too risky, or too far outside the status quo to be worth trying.

The book launches July 29 at RosettaFest in Nashville. Every attendee gets a copy.

Key Takeaways:

• The Rosie Awards evaluate real Plan Grader scores and real reinvestment of the Health Rosetta Dividend, not good intentions
• The appendix of Relocalizing Health is built from Rosie Award case studies, documented proof that the model works in normal organizations
• The organizations in the appendix are not wealthy, not in major metros, and not operating with special advantages. They are the answer to the objection that this would never work at scale.
• Results documented across Rosie Award winners include eliminating deductibles and copays, saving millions while keeping public sector budgets intact, and building direct contracting relationships with providers
• The people behind these results are at RosettaFest 2026 in Nashville, ready to share everything they built

Resources Mentioned:

• Relocalizing Health by Dave Chase: pre-order on Amazon now
• RosettaFest 2026: RosettaFest.org
• Health Rosetta Plan Grader: healthrosetta.org
• Rosie Award winners PDF: available at RosettaFest.org

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/

When people hear the phrase relocalizing health, a lot of them assume it is a slogan, a policy proposal, or someone's political talking point. This episode explains what it actually means.

Dave Chase defines it plainly: treating your community's healthcare dollars as a community resource instead of an extractive expense that leaves town the moment it is spent.

Most communities, healthcare is the biggest industry. Most companies, it is the second biggest cost item. And most of the money flows straight out to distant corporations and shareholders. Dr. Michael Fine calls it medicine as colonialism. Dave calls it extraction dressed up as care.

In Ashtabula County, Ohio, roughly $450 million leaves the county every year. That is not a healthcare problem. That is an economic development catastrophe.

Relocalizing means keeping that money home.

But this episode goes deeper than a definition. Dave explains why every major reform effort has failed, regardless of ideology, and why they will keep failing until two structural flaws are addressed. The first: healthcare and social care are funded and governed in entirely separate silos, even though 80 to 90 percent of health outcomes are determined by things outside of the healthcare setting, like food, education, housing, and transportation. The second: healthcare decisions are made at the wrong scale, either way too large at the federal or state level, or way too small at the individual provider level, missing the Goldilocks zone of roughly 25,000 to 700,000 people where community-scale governance actually works.

He then shows what right-sized governance looks like in practice. Jonkoping County in Sweden. The Nuka System of Care in Alaska. Rosen Hotels in Orlando. Ashtabula County in Ohio. Different politics, different governance structures, different geographies. Identical in two things: integrated funding and right-sized governance.

And he closes with the most American story he knows. Rural electrification. A century ago, less than 10 percent of rural America had electricity. Private utilities said serving rural America was impossible. Communities formed electric cooperatives and did it themselves. By the 1950s, 90 percent of rural America had power. Today almost 900 cooperatives serve 42 million Americans across 56 percent of the US landmass.

That is the playbook. The pioneers in this book are the farmers laying line before anyone in Washington figured it out.

Key Takeaways:

• Relocalizing health means treating your community's healthcare dollars as a community resource instead of an extractive expense
• Dr. Michael Fine frames the status quo as medicine as colonialism: colonial powers extracting both money and wellbeing from communities through the healthcare system
• Ashtabula County: $450 million extracted annually from a county of 100,000 people. That is not a healthcare problem. That is an economic development catastrophe.
• Two structural flaws explain why all reform fails regardless of ideology: (1) healthcare and social care are funded and governed in separate silos even though 80 to 90 percent of health outcomes are determined by social factors, and (2) governance operates at the wrong scale
• The Goldilocks zone for right-sized governance is roughly 25,000 to 700,000 people. County scale. District scale. The size of Iceland.
• The master key: when one entity invests in prevention but a different one reaps the savings, no one has a reason to invest upstream
• Jonkoping County, Sweden: unnecessary hospital days for complex patients fell over 90 percent. One hospital cut staff beds by 30 percent. Cost of care in the last two years of life cut nearly in half. Population: 120,000.
• Nuka System of Care, Alaska: ER visits down 43 percent, hospital admissions down 53 percent. Went from worst health outcomes in America to some of the best.
• Rosen Hotels, Orlando: cut healthcare cost inflation to match regular inflation. Savings poured back into employees and the surrounding community.
• Sweden used a county council. Alaska used a tribal council. Ohio used public and private employers. Florida used a hotel company. Different every way except two things: integrated funding and right-sized governance.
• Multi-stakeholder cooperatives serve 12 percent of the population in Italy and provide 85 percent of care services for elders, children, and the disabled in Bologna
• Rural electrification: by the 1950s, 90 percent of rural America had power through cooperative ownership. Today 900 cooperatives serve 42 million Americans across 56 percent of US landmass.
• Father José María Arizmendiarrieta built Mondragón from a technical school in a war-scarred Basque town under Franco's dictatorship into the largest cooperative complex in the world. If it could be done there, American communities reclaiming their healthcare is not idealistic. It is almost modest by comparison.
• Ronald Reagan praised cooperatives as people's capitalism. Bernie Sanders praises them as democratic institutions. Cooperatives are genuinely post-political.

Resources Mentioned:

• Relocalizing Health by Dave Chase: pre-order on Amazon now
• On Medicine as Colonialism by Dr. Michael Fine
• RosettaFest 2026: RosettaFest.org
• Health Rosetta: healthrosetta.org
• Nautilus Health Institute

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/

The short version is that a close friend died from a preventable medical error and left behind a ten-year-old daughter. That is where this started.

But the longer version, the one Dave tells in this episode, is about what that loss made him unable to stop noticing. How the system he had spent his career inside, building technology for health systems and working at the intersection of healthcare and innovation, was not broken by accident. It was built this way. And the people inside it, the physicians, the administrators, the insurers, were not villains. They were operating exactly as the incentives demanded.

What changed for Dave was not discovering a new problem. It was deciding to stop optimizing inside a broken model and start documenting the communities, employers, advisors, and clinicians who had already figured out how to build something better. This book is that documentation.

He also talks about what the title actually means. Relocalizing health is not a policy idea. It is not a theory. It is something that is already happening in Alabama, Alaska, Ohio, Wisconsin, and Florida, the communities that anchor this book. It is what happens when healthcare dollars stop leaving a community and start building it instead.

The book launches July 29 at RosettaFest in Nashville. Every attendee gets a copy. You can pre-order on Amazon now.

Key Takeaways:

• A close friend's death from a preventable medical error left behind a ten-year-old daughter. That loss is where the decade of work started.
• The system is not broken by accident. It was built this way. But the people inside it are largely operating exactly as the incentives demand, not as villains.
• Dave spent years inside healthcare technology, building software for health systems, working at the intersection of innovation and care delivery. That proximity made the dysfunction visible in a way it might not have been from the outside.
• The turning point was deciding to stop optimizing inside the broken model and start documenting the places where people had already built something better.
• Relocalizing health is not a policy idea. It is not a theory. It is something that is already happening in the communities in this book.
• The Health Rosetta Dividend is the financial expression of this: when employers build the right kind of plan, they generate real savings that can be reinvested into people and communities. The communities in the book prove this over five, ten, twenty, and thirty-year timelines.
• The book is a field manual, not a manifesto. It is written for employers who are done overpaying, advisors who want to build plans they can stand behind, and community leaders who understand healthcare cost as an economic development problem.
• With AI displacing workers at scale, the communities that capture the AI Catalyst by redirecting healthcare savings into workforce development will be the ones that build durable economies. The communities that do not will pay what Dave calls the AI Tax.
• The tools are now democratized through the Nautilus Health Institute. The playbook exists. What is needed is the courage to act, community by community.

Resources Mentioned:

• Relocalizing Health by Dave Chase: pre-order on Amazon now
• RosettaFest 2026: RosettaFest.org
• Health Rosetta: healthrosetta.org
• Nautilus Health Institute: nautilushealthinstitute.org

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/

In 2011, Patrick Blackholder was the CFO and COO at Rice Lake Area School District in northwest Wisconsin. Facing a mandated budget cut, he built a $1,500 deductible into the health plan. It seemed reasonable. It seemed responsible.

A secretary came to his office. Her husband was out of work. Bills had stacked up. She said plainly: I cannot afford $1,500. I will not use it. Two years later, she died of cancer. She had avoided care until it was too late.

Patrick said it as directly as a person can: that had a massive impact on me and how I thought about healthcare. I did not want this to happen again.

That moment grew into the Employers Healthcare Cooperative of Wisconsin, which now covers 23,000 lives across the state.

This episode is the story of how it got there. How Patrick rebuilt the plan around one insight: the answer was never to make expensive care more expensive for people who cannot afford it. The answer was to make the right care available for free.

How one broker named Sarah Paints said yes when almost no broker in Wisconsin would touch it. How in year one Patrick called it a dumpster fire, working 40 extra hours a week on top of his actual job, fighting a hospital CEO who summoned him to an office to deliver ultimatums. How he looked that CEO in the eye and said: go ahead, balance bill every member. How the VP of contracting stepped in immediately and they got a direct deal.

How a surgeon who lost a $59,000 procedure to a direct contract called Patrick to find out why. How they talked. How the surgeon discovered how little of that $59,000 he was actually seeing. How he went out and built his own surgery center and now collaborates with the cooperative.

How some groups cut their costs 45 percent in year one. How others held their costs flat for eight years while comparable groups rose more than 80 percent. How an independent actuary found cooperative groups running 22 percent better than comparable groups overall.

And how Rice Lake, which built all of this a decade ago without a playbook and without ever finding the Health Rosetta community until 2023, is now an active part of that community, and is coming to RosettaFest 2026 with at least 15 of their members.

Patrick Blackholder will be in the room in Nashville.

Key Takeaways:

• Patrick Blackholder built a $1,500 deductible into the plan in 2011 during a mandated budget cut. A secretary who said she could not afford it died of cancer two years later after avoiding care. That moment became the reason everything else happened.
• Wisconsin is one of the most expensive states for healthcare with some of the most egregious price gouging hospitals in the country
• Patrick's core insight: the answer is never to make expensive care more expensive for people who cannot afford it. The answer is to make the right care available for free.
• Sarah Paints was the one broker in Wisconsin who said yes. She later left her firm when it would not support the model and still serves cooperative groups today
• Year one was a dumpster fire — Patrick's own words. Reference-based pricing with almost no contracts, less than two months to launch, a workforce that mostly disappeared for the summer
• A hospital CEO summoned Patrick and the superintendent to his office, spent ten minutes making threats, and told them to pay the billed charges or he would start balance billing employees. Patrick told him to go ahead. The VP of contracting stepped in immediately. They got a direct deal.
• Three of nine school board members lobbied to fire Patrick. The superintendent held the line.
• Patrick drove across northwest Wisconsin negotiating contracts procedure by procedure. Every place an employer could not get good access became the next stop.
• Walker Forge president Brian Adesso proposed the cooperative in 2021 with beautifully simple logic: schools already cooperate on things they cannot afford alone. Why not this?
• The cooperative now covers 23,000 lives. Member pitch: we have more than 20,000 belly buttons.
• Two cancer cases caught early because members came in for routine physicals that were free. A provider said flat out: without the free clinic, these would not have been caught.
• A $59,000 procedure moved to a direct contract alternative. The surgeon called to ask why he lost the case, discovered how little of $59,000 he was actually seeing, and went out and built his own surgery center. He now collaborates with the cooperative.
• Some groups cut costs 45 percent in year one. Others held flat for eight years while comparable groups rose more than 80 percent. Independent actuary found cooperative groups running 22 percent better overall.
• Rice Lake built all of this from scratch without a playbook nearly a decade ago and did not find the Health Rosetta community until 2023. They are now active members and coming to RF26 with at least 15 member employers.

Resources Mentioned:

• Relocalizing Health by Dave Chase: pre-order on Amazon now
• RosettaFest 2026: RosettaFest.org — Patrick Blackholder and at least 15 cooperative members are attending
• 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/

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/