Ashtabula County is one of the poorest counties in Ohio. It was a medical desert, hemorrhaging $450 million a year to distant corporations. Then a school district, a nurse navigator, a primary care doctor, and a pharmacist built something different. Here is what happened.

Mike Chupp is a funeral home director in Ashtabula, Ohio. Over his career, he noticed something he could not stop seeing. Every fourth body he prepared had not even reached his own age. He had restored a man for his family using a photograph of the guy coaching his sons in football, and he would wonder: was that inevitable? Or was that a decade of healthcare failure showing up at the end?

Hold onto that image, because it is the heart of what this story is about.

Ashtabula County is one of the poorest counties in Ohio. Roughly 100,000 people. At least 30,000 living in medical debt. One primary care doctor for every 3,500 residents, against a national average of one per 1,300. Not a single independent primary care physician left. The system had bought them all. And at approximately $1.4 billion flowing through that county every year, a conservative estimate put at least $450 million of it being extracted out of that community annually to distant corporations.

That is the extraction Relocalizing Health is talking about. And Ashtabula decided to keep that money home.

The Team That Built It

Bryce Heimbach is a benefits advisor who had his own reasons for getting into the industry. At 22, he survived open-heart surgery and was uninsurable before the ACA. By 2018, he was successful by the old measures of the industry and miserable. A mentor shared Dave Chase’s TED Talk and book. Bryce joined the Health Rosetta community at the very first gathering in Chicago in 2018. That became his turning point.

His metaphor for what they built is one of the best in the book. Think of a championship football team. Nurse navigators are the fullbacks clearing the way. The primary care doctor is the running back, the workhorse. What wins is not individual stars. It is constant communication and alignment across the whole team.

Casey Billington is a registered nurse. She co-founded Concierge Nurse Navigators. Nurse navigation had existed in oncology but not in the rest of the healthcare system. Their philosophy in one sentence: all members need is someone to guide them to quality, cost-effective care. Nurses are the most trusted profession in America and have been for decades. The blend of clinical, financial, and emotional support they provide becomes more critical the more serious the health issue is.

Dr. Brad Schneider had been on the hamster wheel at a big hospital, seeing 30 patients a day, 15-minute visits if he was lucky, double-booked, and had lost the connection to why he became a doctor. When Bryce called, he drove 45 minutes each way to practice medicine the way he trained, using previously unused space at a school.

Maria Fowler owns Hoffman’s Pharmacy, one of the last independent pharmacies still standing. The giant chains and PBMs had cut her out of the loop. She became the preferred pharmacy for the plan. Generic medications became free for members. It was unlike any other plan she had seen.

What It Actually Did

Start with the school district because that is where the story hit hardest and spread fastest.

Ashtabula Area Schools is the 8th poorest school district in Ohio. They were spending more than 20 percent of their general fund on healthcare. In July 2020, they implemented the new plan. In May 2021, less than a year later, a school levy failed. Normally that would mean cutting teachers, programs, transportation, and extracurriculars. But in less than a year, the plan had already saved approximately $2.4 million, more than the entire levy would have raised.

One of the teachers married the city manager. The city of Ashtabula, about 50 employees, started the same journey and saved approximately $360,000 in year one. Then the county followed. Then private sector employers followed.

A police detective named Wesley Burns was out of town when his 11-year-old daughter broke her ankle. He called the concierge nurse. By the time he was on the interstate, everything was handled. Calm. Straightforward. A teacher named Maureen Cerbella stopped having to pay for her life-saving medications. It felt like a $3,000 raise.

The plan started direct contracting with Crystal Clinic, the number one surgical facility in Ohio. Members happily drove an hour or two for zero cost share and the best outcomes in the state. Crystal Clinic got so much volume they eventually opened a clinic right in Ashtabula County, starting to reverse the medical desert dynamic.

The Pushback Was Proof

The dominant regional hospital system pushed back hard against price transparency. Bryce put it plainly: when the status quo fights something that hard, they are not fighting bad ideas. Bad ideas fail on their own. They were fighting because it worked.

A hospital CEO summoned Patrick and the superintendent to his office and spent ten minutes making threats. Patrick told him to go ahead and balance bill every member. They would dispute every bill and take it to the local paper. The VP of contracting stepped in immediately. They got a direct deal.

The unions asked a pointed question: you are telling me this can be free and you will validate that the physicians are the highest quality? That is what it said. After that conversation, the union healthcare committee became the strongest advocates. They want as much money in their members’ pockets and the best quality care they can get.

The Model Traveled

Bryce and his partner Frank Stichter took what they built in Ashtabula west. They helped launch a community-owned health plan on the Western Slope of Colorado. The model has traveled to other communities around the country.

The elixir from Ashtabula is simple: better healthcare is possible, communities can be transformed, and you just need leaders willing to start in their own backyard. They did it in the 8th poorest county in Ohio, a single-hospital town. The excuse that anyone else cannot do it is wearing very thin.

Bryce Heimbach at RosettaFest 2026

Bryce Heimbach is part of the Employer Track at RosettaFest 2026, July 29 to 31 at the Gaylord Opryland in Nashville. He will be in the room and he is open to sharing everything.

Pre-order Relocalizing Health by Dave Chase on Amazon now. The full Ashtabula story is in the book.

Get your ticket at RosettaFest.org.