Case Study: The Poorest County in Ohio Kept $450 Million Home and Changed Everything

[00:00:00] Before we start, I want to invite you to Rosetta Fest 2026 in Nashville. This is where employers, unions, and clinicians who are cutting healthcare costs 20-50% while improving care and outcomes share exactly how they did it. Operators learning from operators with patients at the table. Learn more and register at rosettafest.org. Now let's get into today's conversation.

[00:00:25] Hey there, welcome to a special series within the Relocalizing Health podcast as we count down to Rosetta Fest in Nashville July 29-31. Each one of these episodes is a quick look inside the book and the communities that inspired it. Real places, real numbers, real people who decided to stop waiting for somebody else to fix healthcare and just built something better themselves.

[00:00:53] You don't have your ticket to Nashville yet. Go grab it at rosettafest.org. This is where people in these stories will actually be in the room with you, very open to sharing their methods and excited to have you copy it and run with it in your community. So let's get into it.

[00:01:21] I'm going to start this story with an experience from a funeral home director because that's where the story hit harness for me. The funeral home director's name is Mike Chupp.

[00:01:33] In Ashtabula, Ohio. And over his career, he noticed something he couldn't unsee. Every fourth body he prepared hadn't even reached his own age. He'd restored a man for his family using a photo of the guy coaching his sons in football. And he'd wonder, you know, was that inevitable? Or was that just the decade? Was that a result of decades of healthcare failure?

[00:01:55] And hold on to that. And hold on to that. And hear the contrast because this is the heart of what we're talking about, what the system has become versus what it's becoming or can become. And this is not a wealthy place. It's one of the poorest counties in Ohio. And it's a county of about 100,000 people where at least 30,000 people are living in medical debt.

[00:02:17] And it's become a medical desert, less than one third the level of docs. Only one primary care doc for every 3,500 people against an average is about 1,300, every 1,300 people.

[00:02:30] Not a single independent primary care doc was left. The system had bought them all. And at about $1.4 billion flowing through that county every year, a conservative estimate is of least $450 million of that was being extracted out of that town every year to distant corporations.

[00:02:50] And that's the extraction that this book is talking about and has the fixes for. And I'm not telling you to make you angry. I'm just telling you because Ashtabula decided to keep that money home. And it absolutely has been working well. And it's really an ensemble story. And so let me introduce the team because the people are really everything to this.

[00:03:14] And it started with a benefit advisor named Bryce Heimbaugh. At 22, he'd survived an open heart surgery, which had made him uninsurable before the ACA. And it's one of the reasons he got into benefits. But by 2018, he was successful by the old measures of the industry, but frankly was miserable and looking at leaving the industry.

[00:03:35] But a mentor, you know, had given him another path by sharing my TED Talk and my book. And Bryce had said, you know, before he'd had success by the old measures selling lots of insurance for enormous carriers, but he was failing the people he wanted to really serve. And he found this health Rosetta model and actually joined it in time for our very first gathering, which was in Chicago in 2018.

[00:04:05] And that really became a turning point. He didn't know exactly where he'd take this all, but he really got the best metaphor in the book. And he says, you know, it's kind of like thinking about a championship football team. And the nurse navigators are the fullbacks, clearing the way. The primary care doc is like the running back, really the workhorse. And what wins in this isn't the individual stars.

[00:04:33] It's that constant communication alignment across that team. And Casey Billington, she is a registered nurse. She was the co-founder of the concierge nurse navigators, which they took the individual stewardship part of the health Rosetta blueprint and took it to another level. Nurse navigation had happened in oncology, but really not in the rest of the system. And you could boil down their philosophy in one sentence.

[00:05:04] You know, all the members need is someone to guide them to quality, cost effective health care. And that's what they wanted to do. That's really what nurses across the board want to do. And, you know, they're in the most trusted profession in America and have been for decades. And that blend of clinical, financial, emotional is really critical. The more serious the health issue is. And then there was Dr. Brad Schneider.

[00:05:31] He'd been on that hamster wheel at a big hospital as a primary care doc, seeing 30 patients a day, 15-minute visits if he was lucky, getting double booked. And it really told me that he had lost the connection of why he'd become a doctor. So when Bryce called him, he was happy to drive the 45 minutes each way. There was extra room in the school. And two or three days a week, he'd come up.

[00:05:59] And they used this previously unused room and practiced medicine the way he trained. And I'd just call him real primary care. And then it was Maria Fowler. She's a pharmacist. She owns Hoffman's Pharmacy. It's one of the last independent pharmacy standing. And she'd been cut out of the loop by giant, you know, pharmacy chains and PBNs and the markups. And instead, what they did was they made them the preferred pharmacy.

[00:06:29] They made generic medications free for members. And it was unlike any other plan that she had seen serving the individuals that she saw in her pharmacy. But the result was really what makes it so interesting. And I'm going to lead with the school district there because that's really the soul of it. And that's what really caused it to spread more rapidly. Actually, the area schools is one of the poorest districts in the state. I think the eighth poorest school district.

[00:06:58] And they were spending more than 20% of their general fund on health care. And that's money that's stolen away from classrooms. Back in 2011, Bill Gates actually gave a tent talk on how health care is devastating education. Now, this is a small school district, only about 300 staff. They put in the new plan in July of 2020.

[00:07:22] And then in May of 2021, even though it was a very challenged community that normally would have successful school levy elections, that time the school levy failed. Normally, that would have been a disaster. You know, cut teachers, programs, transportation, extracurriculars.

[00:07:44] Happily, even in that short amount of time, less than a year, they'd already saved more money, about $2.4 million, than the entire school that would eat. And that was just really a game changer. And it turns out, one of the teachers married the city manager. So there's a small city of Ashtabula, about 50 employees. And they started down this journey as well. And the first year, they saved about $360,000 as well.

[00:08:12] And that's, you know, really what has rippled throughout the community. And then it went to the county and, of course, private sector employers like, wait a second. I thought we were more nimble and sharper about managing our dollars in public sector. And they copied it as well. But here's what it feels like for, you know, the actual people receiving care. You know, Wesley Burns is a police detective.

[00:08:38] His 11-year-old daughter broke her ankle when they're out of town while they're playing a sport. He didn't know what to do. And he's got a little girl crying, but he just decided to call the concierge nurse. And by the time he was on the interstate, they knew exactly what they were going to do. Everything was calm. Everything was cool. And it was just a very straightforward process.

[00:09:00] You know, another member of this plan, a teacher, Maureen Cerbella, she said she just stopped having to pay for medications. It was like she got a $3,000 raise because she had to spend $200 to $300 every month normally for life-saving medications. And things like copays were waived. Deductibles were waived. And so it was really tremendous for her. And then they went and direct contracted with Crystal Clinic.

[00:09:28] This is the number one surgical facility in Ohio. And members happily drove an hour or two for zero cost share, top quality, the best facilities, the least complications. And eventually, Crystal Clinic got so much volume, they opened up a clinic right in Ashtabula. And, you know, it's starting to chip away at that medical desert dynamic.

[00:09:52] But, you know, people are willing to drive when on the one option they have super high deductibles, super high cost sharing, and questionable quality versus the best quality at a fair price. But this took some political courage. I want to gloss over that. In the public sector, most leaders think they're playing it safe by just going with the status quo. But these folks didn't do that.

[00:10:19] More and more, what's happening is public sector entities are really, you know, put into a position where they really don't feel they have a choice. That's why we see so many public sector employers adopting health Rosetta style plans. But, you know, the unions were really a turning point. You know, members and leaders asked Bryce, point blank, you're telling me this can be free? And you'll validate that the physicians you send this to are the highest quality? Yep. Yep. Yep.

[00:10:47] And after that conversation, the union health care committee became the strongest advocates for this. They want as much money in the pockets of their members, you know, and not getting eaten up by health care premiums. Of course, they want the best quality health care they can get. And by the way, they did all this outside of the collective bargaining agreement, period. And so you might think their hands were tied, but there's still a lot of things you can do. You can add new benefits. And that's what they do.

[00:11:17] The superintendent was so convinced that this could help other students throughout the state. He actually paused his career to help go let other school districts, hundreds of other school districts just in Ohio, show that what they might have thought was impossible was absolutely possible. So, yeah, sure. There's going to be a fight.

[00:11:42] The dominant regional hospital system pushed back hard against price transparency because it was a threat to the old model. And, you know, when the establishment fights that hard, you know, you're over the target. And Bryce says it best, you know, in a status quo, fight something so hard, you know, it's they're not fighting against bad ideas. Those would just fail on their own. And so it's really changed the dynamic here.

[00:12:10] And so it wasn't just something you could do in the private sector. Public institutions can do this, too. And the stakes are even higher, you know, because real families are on the other side of every line item. And it doesn't stay put, though. Bryce and his partner Frank Schdichter took the Model West. They helped launch a community health plan in the Western Slope in Colorado. They're taken to other places around the country as well. And I think of this as economic development 3.0.

[00:12:39] I've got a chapter in the book about this. Forget chasing tax incentives. And when you're a high value health care community, it's far better than any tax break to attract or retain a company. And you can get those dollars to rather than be extracted out of your local economy to circulate in that economy and continue to rebuild things from the inside. So, you know, the elixir from Ashtabula is simple.

[00:13:07] You know, better health care is possible. Communities can be transformed. You just need leaders willing to start in their own backyard. They can do it in the 8th Forest County, in Ohio, single hospital town. The excuse that anyone else has just is really wearing thin. So it's absolutely possible. Go make it happen in your community. Well, that's the story for today. If it resonated, the new Relocalizing Health book is going deeper into that. And Nashville goes deeper still.

[00:13:37] So Relocalizing Health comes out July 29th right at Rosetta Fest. Every attendee will get it. You can preorder a copy now on Amazon. And if you want to be in the room when that happens, get your ticket at rosettafest.org. See you in Nashville. See you in Nashville. See you in Nashville. See you in Nashville.