What Advisors, Employers, and Community Leaders Will Actually Find in This Book

[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 29th to 31st. 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.

[00:00:54] 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] Let me talk directly to this. I'm pretty skeptical for a minute because I was one of those people. I know there's a lot of healthcare books that diagnose the problem very well and then leave you with very little to do, you know, on Monday morning if you're in the industry or frankly even in the community that's impacted by healthcare.

[00:01:41] And you finish maybe a little more informed, but just as stuck and frustrated. That's not what this book is about. I wrote a field manual, not a manifesto. And the test I'd held to myself was could an advisor, an employer, a community leader read this and actually do something with it? Not just feel differently, but clearly do something different.

[00:02:04] And it was written for it. And it was written for three types of people particularly, but certainly it's broadly applicable. You know, there's the benefit advisor, what some people might call an insurance agent or a benefit broker. They are the advisor who's ready to build a health plan that actually holds up and is tired of selling the same broken product and calling it a win and just moving on.

[00:02:32] Then there's the employer union who's done overpaying for underperformance, who looks at their renewal and finally says, enough, no more. There's got to be a better way. And there is in fact, and it's been done thousands of times.

[00:02:48] And they start by reassessing who they've apparently, those people have apparently missed that there's decades of crew and methods spanning thousands of employers. And it's no longer a leading edge thing. The new healthcare economy is already bigger than the U S video game industry at about a hundred billion dollars a year.

[00:03:07] And then it's to the community leader. And then it's to the community leader. This is the one people miss. They, you know, they may understand healthcare that the people, but the community leaders, they understand that tackling healthcare dysfunction is really about economic development and community wellbeing. And that every dollar extracted from a dollar that can't build the talent and wellbeing in the community.

[00:03:38] And for each of them, the book is a set of tools, not a sermon. Here's what's genuinely new and why this book lands now and not 10 years ago. The tools used to be locked up. Only a few giant corporations could afford the expertise to do this well. And that's where Nautilus Health Institute came in. It's a 501 C three, and it exists to really change that dynamic.

[00:04:03] It's democratizing the expertise, taking, uh, what was battle tested by the best of the best and making it open source. So whether you're a 200 person employer or you might be a small county, you can use it. And, you know, real example of what's happened is Nautilus has taken, uh, 4 million in direct proven intellectual property, and then kind of untold, uh, value on all the people who are contributing to it.

[00:04:33] People like Marilyn Barlet, who turned Montana state employee health plan from a projected $9 million loss into $112 million surplus. And Chris Deacon, who saved New Jersey billions of dollars and many, many others. There are, these aren't consultants, uh, in Nautilus trying to sell you something.

[00:04:55] They put their playbooks into open tools, model contract language stops vendors from hiding fees and potty rebates that should go back to the employer and employees. Uh, there's procurement templates with vendor scoring. There's data tools. Um, and the idea is what a systems thinker named, um, risk profile falls a fabric like network, not a hub and spoke system that concentrates power in some distant headquarters.

[00:05:25] It's really a fabric like the internet where every local organization stays autonomous, but plugs into these shared resources and shared expertise. So you get the sophistication that a giant corporation might be able to have and the responsiveness of a local organization. You've stopped having to choose between the two. When one co-op develops a great behavioral health approach, it becomes immediately available to every other organization in that fabric.

[00:05:55] Now I want to spend some time on the part of the book I think is most urgent. Uh, I call it the AI catalyst because it reframes this whole movement for the moment we're in. Um, and the setup's this. We have AI is obviously in the zeitgeist and there's been, uh, studies that suggest that seven to 14% of jobs, um, are going to be displaced by 2030. You know, that's just right in the corner. That's millions of people facing displacement.

[00:06:24] Most communities are bracing, uh, to just absorb that hit. I call that the AI tax that they let happen. Unemployment, declining services, economic decline, and you pay whether you want to or not, unless you do something different. And the AI tax isn't either the fact anymore.

[00:06:43] We have now have hospitals funded by billions of dollars of venture capital who are deploying AI right now to extract more from employer plans and public budgets and family finances. Um, here's an example that should hit you very directly. Blue Health Intelligence that the data arm of the Blue Cross Blue Shield Association, they looked at hospitals that are daft of AI aggressively.

[00:07:11] And just to give you one example, postpartum hemorrhage diagnoses jumped from just 4% of maturity admissions a few years ago to over 12%, triple. But the transfusion rates stayed completely flat. So if that tells you is a diagnosis, holds Klein, but the actual clinical care did not. AI didn't make those moms safer. It just learned to build more and harder.

[00:07:38] And, uh, blue health intelligence put a number on it. They attributed at least $663 million in extra inpatient spending and $1.67 billion in extra outpatient spending to AI enabled coding. And that's just across the blue cross blue shield plans alone. That's more than $2 billion a single year from one insurer's book of business.

[00:08:04] That is the AI tax in real time and at machine speed. But here's the twist that nobody tends to see. That same AI that extracts can also automate away the bureaucratic bloat that protects organizations and communities from healthcare waste. The very thing eating our community can fund the thing that saves it. And so let's do the math. It's really kind of hard to fathom.

[00:08:31] Nationally, it's about $1.5 trillion a year in healthcare spending providing no value. This is larger than the entire Russian economy. And if you bring that home down to a typical community of 100,000 people, 30 to 50% of healthcare spending is waste. That's been documented for a couple decades.

[00:08:52] So that means about $450 million in that community of 100,000 people is extracted for no good reason. Now, if you redirect that and stop that, which is what we're seeing communities do all over the Health Rosetta ecosystem, you could fund 3,750 full-time jobs and about $120,000 haul in, you know, factor in benefits.

[00:09:20] That's over 6% of the working age population. That's enough to absorb the AI displacement. Here's the beautiful part. These jobs are exactly the ones AI can't do. This is community health workers where some of the high-performing regions in the country, you know, have 35 to 42 of them per 100,000 people. So there's enormous room to grow. Social workers, educators, recreation and arts coordinators.

[00:09:50] These are the people who build trust and build what makes our community special. They navigate culture. And the people such as social workers and community health workers can sit with somebody in crisis. It's distinctly human work that we have too little of in many of our communities. So the choice in front of every community is stark and simple. You're making a decision whether you choose to make it or not. That is a decision.

[00:10:18] You can pay the AI tax or capture the AI catalyst. And you can let the waste extract your community wealth while you suffer displacement. Or you can redirect that waste into the most human workforce that ever has been built. It's not a tech story that's a relocalizing story. It's the same two structural flaws. You integrate funding, you have a right-sized governance, and you point at the biggest economic transition of our lifetimes.

[00:10:47] And the book's conclusion puts the whole choice in one sentence. It's the difference between an AI tax and AI catalyst. It comes down to leadership and your willingness to act on what you now already know works. So what will you actually find in this book? A blueprint that exists. Tools are now in your reach. Success stories that keep multiplying. The hard part was never really the how.

[00:11:14] The communities in the world proved the how. The hard part is the will. My line on this is, and I mean it. The blueprint exists. The tools exist. What's left is the will to act, community by community. And that's the hopeful place to be. Because the will is one thing that doesn't require permission for anyone. You don't need DC. You don't need a giant insurer's blessing. You just need the courage to start. And now you've got the man. Well, that's the story for today.

[00:11:44] If it resonated, the new Relocalizing Health book is going deeper into that. And Nashville goes deeper still. 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.