Patrick Blackholder built a $1,500 deductible into the Rice Lake Area School District health plan in 2011. It seemed responsible. A secretary told him she could not afford it. Two years later she died of cancer. What he built next now covers 23,000 lives across Wisconsin.

In 2011, Patrick Blackholder was the CFO and COO at Rice Lake Area School District in northwest Wisconsin. The state had mandated budget cuts. He built a $1,500 deductible into the health plan. It seemed reasonable.

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 describes it as directly as a person can. He said 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. It now covers 23,000 lives across the state.

The Wall They Were Up Against

Wisconsin is one of the most expensive states in the country for healthcare. Some of the most egregious price-gouging hospitals in the nation are there. Big systems set the pricing and everyone else follows. Many communities effectively face a monopoly. As school districts got crushed under Act 10, budgets were cut 5 percent while health costs climbed 10 to 15 percent a year. Cut teachers, cut programs, cut benefits. That was the math.

Patrick’s insight about the deductible changed his direction entirely. 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.

His exact words: I had to get people access to basic care at no cost. So I decided we must provide access to primary care free.

Almost no broker in Wisconsin would touch it. One said yes.

Sarah Paints Said Yes

Sarah Paints did not flinch. Patrick said she was one of those rare brokers who said let’s do it. During the worst of year one, she talked to Patrick more than she talked to her own husband. She later left her firm when it would not support the model, went out on her own, and still serves cooperative groups today.

Year one, in Patrick’s own words, was a dumpster fire. They jumped into reference-based pricing with almost no contracts in place and less than two months to launch. The workforce mostly disappeared for the summer so there was barely time to educate anyone. Patrick was working 40 hours a week on top of his actual job trying to fix the healthcare problems.

Then in September, the local hospital system sent a letter. Pay the bills or we will start balance billing your employees.

The hospital CEO summoned Patrick and the superintendent to his office. He spent ten minutes making threats, reminded them the hospital employed 800 taxpayers, and delivered an ultimatum. Patrick looked at him and said in effect: go ahead, balance bill every member. We cannot afford it. They cannot afford it. And we will dispute every single bill and take it to the local paper to explain how you are treating the school district.

The VP of contracting stepped in immediately. They got a direct deal.

Three of nine school board members lobbied to fire Patrick during a closed-door session. The superintendent was in that room and held the line. They had to see this through.

Building It Piece by Piece

Patrick got in his car and drove across northwest Wisconsin negotiating contracts procedure by procedure. Every place an employer could not get good access became the next stop. He says you do not have to do it that way now. There are people who make it much easier. But it shows what is possible when you are willing to do the work.

As he accumulated contracts, he had a different thought: this should not just be for Rice Lake. The value we have created should be shared.

Two other employers that Sarah was working with, Menasha Joint School District and Walker Forge, saw the results and wanted in. In 2021, Walker Forge president Brian Adesso proposed a cooperative. His logic was beautifully simple. Schools already cooperate on things they cannot afford alone. Why not this?

The Employers Healthcare Cooperative of Wisconsin was formed. A five-member board from member employers. Members contributed $2.50 per employee per month plus $250 a month for operations. And Patrick’s pitch to health systems: we have more than 20,000 belly buttons. Something a single 300-person district never could have said now opened doors across the state.

What It Actually Delivers

Every member employer gets a dedicated free primary care clinic. The removal of that barrier is what turns manageable problems into outcomes instead of catastrophes.

Two cancer cases make it concrete. A 64-year-old man who normally would not go to the doctor came in for a routine physical because it was free. Elevated PSA. Aggressive prostate cancer caught early. Five years later he is clear. A woman with cervical cancer, caught at a very treatable stage. Her provider said flat out: without the free clinic, this would not have been caught.

A member’s surgery moved from a $59,000 procedure to a direct contract alternative. The surgeon called Patrick to ask why he lost the case. They talked. The surgeon discovered how little of that $59,000 he was actually seeing. He went out and built his own surgery center. He now collaborates with the cooperative.

The range of financial results: some groups cut their costs 45 percent in year one. Others have held costs flat for eight years while comparable groups rose more than 80 percent. An independent actuary at Windsor Strategy Partners found cooperative groups are running approximately 22 percent better than comparable groups overall.

The Bigger Idea

Patrick quotes the cooperative’s philosophy directly: there is a way to fix healthcare. It is a journey, but employers and the communities they are in have to join together to do it.

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. At last count, at least 15 member employers from the cooperative are coming to RosettaFest 2026 in Nashville. They will be part of the Employer Track and they are open to sharing everything.

The same instinct that built rural electrification a century ago is what is happening in healthcare in Wisconsin right now. Neighbors pulling together to do what none of them could do alone.

Patrick Blackholder is at RosettaFest 2026, July 29 to 31 at the Gaylord Opryland in Nashville.

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

Get your ticket at RosettaFest.org.