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/