How to Build Community Owned Health Plans (feat. Bryce Heinbaugh)

TRANSCRIPT

Click here to listen to the episode, published May 12, 2026.

JOHN: Thank you all for joining us today for another episode of our podcast, Moving to Value Unscripted. My name is Dr. John Rodis, and I'm a recovering ex-hospital president and am proud to be the president of the Moving to Value Alliance. The Moving to Value Alliance, a 501c3 nonprofit, is a multi-stakeholder grassroots organization whose purpose is to foster a community that aims to create a value-based healthcare ecosystem with high-quality outcomes at a reasonable cost for plan sponsors and their members, beneficiaries, or employees. I want to thank our members whose support makes this podcast possible. We'd like to give special recognition today to our trade member, Southern New England Healthcare. I'm joined by my fellow board members, Dr. Steve Schutzer, Lisa Trumble, Kim Lynch, and Donovan Pyle.

STEVE: I'm Dr. Steve Schutzer, orthopedic surgeon, co-founder of the Moving to Value Alliance. I'm also co-founder and chief medical officer of Upswing Health, a national virtual orthopedic company focused on improving patient access, clinical outcomes, and value in musculoskeletal care.

LISA: And I'm Lisa Trumble, the president and CEO of Southern New England Healthcare Organization based in Windsor, Connecticut, a physician-led clinically integrated network focused on population health and value-based care in Connecticut and Massachusetts.

KIM: I'm Kim Lynch, founder and CEO of Metis Health Technologies, where we help clinicians and healthcare organizations streamline operations, increase revenue, and deliver better patient care. I'm originally from Michigan, now based in DC.

DONOVAN: And I'm Donovan Pyle, CEO and founder of Health Compass Consulting based out of Orlando, Florida, author of Fixing Healthcare and chairman of the Validation Institute's Certified Health Value Professional designation.

JOHN: Our guest today is Bryce Heinbaugh, CEO of IEN Risk Management Consultants. It's not a stretch to say that Bryce is fundamentally redefining what it means to be a fiduciary in the American healthcare landscape. He's perhaps best known for his boots on the ground work in localized reform, most notably in Ashtabula, Ohio, where he helped pioneer community-owned health plan model, restoring services in what had been a healthcare desert. His approach proves that by removing the opacity of traditional insurance giants and reinvesting savings back into the local healthcare ecosystem, employers see the value reflected in their bottom lines and patients see it at their bedside. It's no surprise that Bryce is now pursuing opportunities to bring this localized model to communities across the country. Bryce joins us today to discuss his journey beyond the traditional role of a broker to become an architect of transparent, high-performing systems that ensure healthcare remains local, independent, and above all, accountable. Welcome to Moving to Value Unscripted, Bryce.

BRYCE: Hello, and good morning. Thank you for having me. I look forward to this conversation. It's always good to be amongst a brain trust. Your guys' request to have me, I hope that I can share a few case studies and maybe some stories that would allow others to replicate the model wherever they are, whether it's rural America or the suburbs of a large metropolitan area. This is going to be a great conversation.

JOHN: Well, thanks. Thanks, Bryce. We look forward to it. And truthfully, we haven't had anyone on talking about community-owned health plans before. But Bryce, before we get going, let me just ask you to share with our listeners a little bit of your background, kind of how you got it. There's usually either some epiphany or some event happens in people's lives we find that gets them to where they are today. So if you wouldn't mind sharing kind of how you got to where you are, and then maybe just at the end, if you would, just share with our listeners what exactly is a community-owned health plan.

BRYCE: Sure. Yeah, thank you. So my background, I like the epiphany term there. Had a couple of them, but ultimately, age 22 was really a senior in undergrad, final semester, when I had a cardiologist tell me, son, you have a hole in your heart. It's probably been with you most of your life, gone undetected. The news here today is that you need to have emergency open heart surgery. He goes, I give you 30 days. I'd like you to schedule on your way out of the exam room today. You just need to make one decision. You want to do a traditional cut in your chest or you want to go through the groin? Back then, that's 2002, Cleveland Clinic said we've done two successful procedures through the groin. You could be the third. I said, man, I said, what, you know, what's the likelihood I'm going to live the rest of my life and not have any issues because it's this umbrella type procedure. And he said, you know, it's just the traditional way is probably going to be what we would trust. And I said, well, let's go that route. So entering now again, understanding, entering into what was going to be my soon adulthood and career. I had studied finance and accounting, was going to go really on to do big things. I hit the reset button real fast. Prior to the Affordable Care Act, now, this would make me an uninsurable individual, if you guys remember those days.

JOHN: Right.

BRYCE: I was doing my cardiac rehab back home. I moved back home with my mother. And as I was taking baby steps across our living room floor for weeks and weeks, I was studying basically how I was going to procure health care coverage when I would graduate in May, just a few months from then. And so wildly enough, I found my way through necessity. And within that same 365 days, less than 365, I hung a shingle, formed my own kind of consulting or agency in health care. I really just felt I was going to be able to help small businesses. I had no idea what I was doing, but I had credibility. Even though I had hair back then, I looked younger. I had credibility with open heart and that I found a way to procure health care. So starting there, wildly enough, I want to take you real quick to understand how I got into this space because it's not easy. But just about two years after starting my own practice, I ran into a gentleman who was leaving Ohio University, had run their medical school down there. And he said, Bryce, I'm getting ready to run the health care MBA program up in Cleveland at a small liberal arts college called Baldwin Wallace University. You should think about joining this executive MBA program. And I said, I said to the guy, I said, Tom, Tom Campanella, I said, Tom, I'm an entrepreneur. I'm not climbing a corporate ladder. I'm not running a hospital. Why in the world would I even consider doing such a program? And he said, son, it's not about the education necessarily. It's about the handshakes and you need social capital in which you do not have. And I kind of, I, you know, it was, it was candid, but, but I, I understood it.

JOHN: Yeah.

BRYCE: And I can tell you that I signed on, signed the line for a loan for an executive MBA program shortly thereafter. And in that program, I shook the hand of a man that owned an independent third party administrator, guy's name's Jim Farley out of Cleveland. And he said, Bryce, I understand you've been selling insurance type products. He said, but there's an entirely different way to manage healthcare expenses for employers. And it's through self-funding and it's through independent plan administration that gives you the autonomy to create high-performing health plans. And Jim took me under his wing. That was right around 2006. And together, he showed me everything that there was to really know. He'd been a veteran in the business a long, long time. And this is, again, every one of us on the call, we should always be molding someone and teaching others what we've learned and know. And he did that with me. And I respect him for it because whether I was going to be successful or not. He took a chance and we wrote our first independently run self-funded health plan together in 2012. So it took us a little while, but it actually propelled me. And this is what's really cool. You figure Dave Chase and team founded Health Rosetta 2017, Dave's first book, The CEO's Guide to Restoring the American Dream, drops in 2017. And he takes a class of advisors, consultants, and architects. And he says, you know, to influence systemic change in healthcare purchasing, it's advisors and consultants who are leading and influencing employers and organizations how to buy this stuff.

JOHN: Right.

BRYCE: So he wanted to accredit, basically to have an accreditation of guys that would attest to doing the right thing. Here's fiduciary duty starting back then in employee benefit space. And so I threw my hat in the ring. Jim Farley actually said, you got to follow this guy, Dave Chase, read his book. It just came out. He said, you should throw your hat in the ring at his first, you know, advisory group. And I said, Jim, I don't belong in that ring. I don't, you know, I don't have a big giant book of business. He said, no, it's not about that. It's about values and it's about what you're doing already. And so that very first client that we put in together in 2012, I put on my application to Health Rosetta and said, we're already doing all of these really cool things. And so I was, again, early 2018, accepted into Health Rosetta, became one of their first advisors. And then what I will tell you is a revelation moment hit when Dave and I, we got a call from a publicist for the Automotive News, January 2019. And we were featured as a best practice for auto dealers and auto-related businesses in the Bible of the auto industry, the Automotive News. And so that really was kind of the kickstart of, you know, really doing big things nationally. And so with that, I am from this, what we would say is kind of a Rust Belt town an hour east of Cleveland on Lake Erie called Ashtabula, Ashtabula County, Ohio. And so it is my own backyard. And as you guys could understand, sometimes it's really hard, you know, to be accepted or, you know, your own hometown, they have a hard time believing in you or that this is an innovative strategy that works. But I had a gentleman who I knew from the private sector who was a CFO for a publicly traded company, turned more like philanthropic, left his job, moved back into Ashtabula to become the CFO of our local Ashtabula area city schools because they were financially in trouble. And he said, I can help this community. He called me up in 2017, 2018, right at the same time I was going into this Rosetta program. He said, Bryce, we have a spending problem. We're paying $27,000 per employee per year for health care here.

JOHN: Wow, yeah.

BRYCE: And again, this is a very poor, you know, it's the inner city schools, but a very poor community. He said, I'm here, I'm charging forward to fix it. What do you think you can do for us? And so that really led into my very first full advanced primary care model. So we recruited a family physician. I actually helped the gentleman start his DPC practice from the software to the billing software to the telemedicine. And so we launched DPC in 2019. At the same exact time, we had filed for our own entity. We have a nurse navigation company that came out of this entire process. And so we have a very, very — my nurse navigation company is now larger than our consulting arm. Okay. But we, so direct primary care, nurse navigation, and then in defining a community-owned health plan. Really, it's taking, you know, bringing back and looking for local independent providers, not just physicians, but providers in general, community pharmacists. So I reached out and I've had the gal with me maybe at a DPC conference. She spoke, but I reached out to our only last standing community pharmacist. And it's funny, but she said it before. She says, Bryce, I remember the day JFK was killed, the day 9/11 happened and the day you called my pharmacy. I was on the brink of closing.

JOHN: Wow.

BRYCE: And you asked if I would want to be integrated into this health plan that you were putting together for the school, the city and these other private businesses. And so we have really it's it is it's a — it's siloed because they're different entities, DPC, you know, nurses and pharmacists. But we launched Advanced Primary Care January 2020 here in this county for a multitude of businesses and organizations, the schools, the city and private sector businesses. And from that point forward, this thing, this community-owned health plan, we just began to work with local providers, contracting, direct contracts, removing unnecessary money-handling middlemen, as Dave Chase likes to say. But we don't need the money to leave this community. We need it to stay right here. So I went out to chiropractors, PT clinics, mental health providers, and said, hey, you guys want to participate in this. You'll get paid. If our nurses navigate patients to any of these providers, the patient pays zero. There's no out-of-pocket cost for the patient. And of course, you know, the provider saying, wait a minute, we don't have to deal with chasing down, you know, member responsibility. And in many cases, you know, prior authorizations can be, you know, stepped aside. And so we began to do this and replicate again and again in Ashtabula County, Ohio. And this was our first experience in really creating a COHP. And it has been a lot of fun. I will tell you that that was, again, 2019, 2020, when we barely, you know, I was holding my grin saying, this is going to work. We're going to create better health outcomes. We're going to close gaps in care. But at the same time, trusting that everything I'd been learning through Health Rosetta and, again, key people that I was learning, you know, meeting through Dave Chase and others, that they wouldn't do me wrong, you know, vendors that I would bring into this play. You know, from the very beginning, we've done all diabetic supplies free and on all of all these plans, we've done durable medical equipment, CPAPs, all the supply, all these things free. And so it's been now we're six going into seven years. And this program is, it's highly impactful. We just did a quick, for this conversation, I said to my staff, I said, hey, because hospital price transparency rules going into place as well to say, I mean, this just keeps getting better. So I said, hey, run me just for city schools in the city of Ashtabula, run me how many MRIs that we have volume that we've used our high value provider for MRIs, which is a, it's a $700 all in MRI with or without contrast. That's the read everything. I said, run me how many we've done since the price transparency rules. 325 for these two entities. I said, okay, 325. I said, and the average price here, I don't need to name the hospitals that rule the roost here, but you know, so we've saved $406,000 doing that.

JOHN: Right. On that alone.

BRYCE: In just MRIs since hospital price transparency rules went into place. And none of those patients had to pay a dollar for it. They didn't have to worry about the cost. And I can tell you, it goes true to infusions. It goes true to, you know, any of these big things employers are really struggling with the cost of anyhow. So this is the story. And again, we can replicate it. We've done it really successfully out on the western slope of Colorado. We've done it. We're doing it. Actually, some of you are from New England states. We're working in Maine right now, in Rhode Island right now. These communities have reached out to us and said, and providers, how can we do this right here? And show us how. And so you can do it anywhere. It's just having a little bit of influence and people who are on the same guiding principles that we want to systemically change how healthcare is being delivered in this country.

JOHN: Wow. Thank you, Bryce. What a great story. And just life is, of course, a lot of twists and turns and you certainly took them, but you've managed to take every one of those twists and turns and turn it into a positive. And obviously for the people of Ashtabula County, actually, more than just the town, you've changed their lives and health trajectory. So thank you so much for that.

LISA: Yeah, Bryce, it's a fabulous story. I work in an organization where, you know, we're focused on population health and believe strongly that the answers are local, they're not national. And, you know, one of the flaws in our healthcare system is, you know, we've over decades built up these national health plans that try to take, you know, one model and deploy it everywhere and say, oh, it works. And then you got all the middlemen, as you pointed out, and in between. And by the time you get done with it, all the dollars have been used up and there's very little left to save the employer, pay the provider for the work and avoid the cost share with the patients. I really believe a community approach is the right answer. And so I'm wondering, I know you're doing it in pockets. Do you find that it is more successful in the more kind of rural, small community area versus, you know, a bigger metropolitan area? And if so, how can we get from a small community to a metropolitan or statewide approach to something like you're doing?

BRYCE: Great question, Lisa. Thank you. I truly believe it. It's easier in the smaller rural type settings or communities because really the social capital, you know, the city manager, the mayor knows the school board president and the school board president knows, you know, X, Y, Z people that serve on the board there and their influencers. So it's easier just because of that, you have more people that can just push forward and it's a better story to tell. Also, places that have — again, you can look at social determinants and you can also identify for us, we're a health care desert for labor and delivery. We have two major academic health systems, both sides of us. To the west, we have the Cleveland Clinic. To the east, we have UPMC, right? Erie, Pennsylvania is 30 minutes from here. I can tell you that although we have these, again, world-class academic institutions, the people right here, just a little bit further away, we're lacking a lot of things. I mean, even mental and behavioral health providers, there's a giant shortage here because the only mainstay mental and behavioral health provider turned to a federally-qualified health center and no longer accepts anyone other than pretty much federal dollars. So there's no commercial, no employee from any of our health plans can seek care there. And so I think that the story really goes well in the rural communities where you can bring in possibly outside providers. Maybe it's even virtually. So for us, one of our solutions for mental health is we have a fantastic vendor who helps us with, again, psychiatry, psychology, psychotherapy, nutrition counseling. It's all done virtually. It is fee for service. It's OK. It's a good price we contracted with. But they provide great service and establishing care for people. But the rural communities, I think it truly is easiest to kickstart. It can be — and in fact, Donovan, you mentioned you're in Orlando. It can be done in major metropolitan areas. Orlando is a good and easy one. Orange County, Florida. Only because a lot of the beginning, you know, when Dave Chase was helping to really formulate Health Rosetta, who did he go down and actually listen to and take a book of notes with? It was Harris Rosen. Of Rosen Hotels. Yes. And what did Mr. Rosen do? He created on-site, near-site clinics, primary care, chiro, pharmacy. He created his own right there throughout his hotels. But you have now other employers in greater Orlando, like Osceola County Schools and others who I know full well, including we have some clients that tap into the exact same, we call it ecosystem, that same plan and program that Mr. Rosen put together there, the network, the direct contracting, direct primary care, the pharmacies. And so I think it's probably in the larger areas, it's really just you need scale, you know, Because the first question, these bigger, when there's a highly competitive healthcare market, they want to know how many belly buttons are you talking about? What's the steerage going to look like? And that's so hard to say. But nonetheless, yes, you can do it. But I love the story of rural communities. And I love places like West Virginia, Appalachia, even out in the Mountain West. It's possible anywhere.

STEVE: Well, Bryce, you and I — I met you, at one of your sessions two years ago, RosettaFest. And I must say that when I heard your talk, it was, it was love and respect that hello. I mean, this is to me, healthcare nirvana. Seriously. It's just, I said, there is hope here, but you know, to John's earlier point about twists and turns first, congratulations from going from open heart surgery to marathon runner, that alone, that, that speaks volumes, an endurance runner.

BRYCE: Thank you.

STEVE: But just to go back to your model. Tell us a little bit more about the corporate structure and the governance. Is it a B Corp, C Corp, nonprofit? Who are the decision makers? Can anybody use it or just the school system? Fill us in a little bit more.

BRYCE: Yeah, great question. Really, anyone can use it. We work both in the public sector, private sector, and also heavily in nonprofit organizations who really tend to need it the most. Wildly enough, and again, I don't know if I've stated this publicly or not, but we studied this in the last 12 months and began to realize that just over half of all of our revenue in our consulting company and our nurse navigation organization, over half our revenue comes from religious organizations for us, which is kind of crazy to think about. But a lot of Catholic dioceses, a lot of ministry sharing plan type folks, we have some Protestant megachurches. But if you think about religious organizations, they want to take care of their people. Most of these folks are, you know, either, I don't want to say middle class, but some of them, many working poor, and they're just trying to get by. But if they could take care of their people and their healthcare, waiving costs and giving, you know, a lot of these things, then they can do a lot of really good work. And so Health Rosetta itself, public benefit corporation, we utilize Health Rosetta on 100% of all of our client engagements. They serve as our data warehouse. They work with our analytics and a lot of the strategies and kind of governance of the fiduciary role that we play as an advisor or architect really comes from Health Rosetta. We're really big on, you know, just price transparency and the things that policy in Washington has been a little bit slower. You know, we started much sooner doing these things. But I will say to you, the easiest way to get these off the ground, especially in any organizations where you've got labor involved, multiple unions, we always, and even in private sector, we will always recommend, begin with a health care committee. Don't let just the HR person make the decision or the CFO. You need a health care committee. And that's going to be made up of maybe it is some union leaders. Maybe it's a union president. You know, the most recent labor group that we lifted January 1st was actually Ashtabula County government themselves. I think there were 11 labor unions in there. And so we had some really big meetings. It took it took a while, but we we wanted everyone to feel comfortable that this is not a top down approach. We're doing the best we can for everyone. And this is the reason why we need their emotional intelligence, minds and hearts to buy into this model. This is going to help not only themselves, their families, but the community itself.

JOHN: Brilliant.

BRYCE: And that's kind of that revelation moment when the buyers and the committees begin to see it that way. Man, there's no, like — I just got numbers and I just want to share with you. We launched a second direct primary care brick and mortar practice in the county seat on January 1st. It's 500 steps from the courthouse for the county workers and the jails there and all these things. In less than 100 days, we had 292 patients establish care with their new DPC offering, which is brand new. You know, there's about 600 employees, 1,800 total members, belly buttons as we call them. And in less than 100 days, nearly 300 people have already established care with their DPC. Don't have to worry about access problems. They get the doc's phone and they can walk right across the street. and in that DPC, this is the fun of it. Now, do I do this everywhere we go? No, but understand my backyard, it's community service in my mind. I helped the doctor procure the building. So he owns the building. I convinced some of our other providers. So we have a chiro practice that came into that building, a PT clinic that came into the building. I just got off the phone truly yesterday morning with Quest Diagnostics. They're going to make a draw site for them in the building all to serve these populations and all of it free for every patient that walks in that door.

JOHN: Wow.

BRYCE: And by the way, the community pharmacist is delivering the meds there as well. So, I mean, this is, it's really, it's nirvana, as Steve said.

STEVE: It is nirvana.

BRYCE: I mean, but it feels, you know, I lay my head, is this hard work? I tell people it's some of the hardest work you could imagine. It's, you know, it's hard. These days are long, but man, when you lay down and you rest your head on a pillow, you know, man, you're doing really, really legacy type work.

STEVE: Wow.

KIM: Bryce, I want to pick up on that exact thread because it's electric to hear you talk about this because it is real and it is happening and it is changing people's lives today.

BRYCE: Yes.

KIM: You talked a few minutes ago and dropped the $27,000 per capita number for Ashtabula County. And that has really stuck with me. And you also talk a lot about the Nuka system in Alaska, which I love. And I want to give you a chance to talk about because — the Nuka system, my understanding, it's half of the per capita costs that we see nationally. They're in the like $7,000, $8,000 per capita range, as opposed to the typical $14,000, 15,000 per capita range and 50% fewer ER visits, 65% drop in specialty care and 98% patient satisfaction in Alaska for the whole community, right? I want to just give you the opportunity to riff on that and the light bulb moments that you're talking about that happens in communities when they realize they're not just on defense, they can be on offense in creating the community and the care that they want.

BRYCE: Yes, absolutely. Kim, that's a great point. Years ago, I ran across Darrell Moon, who had promoted the heck out of the Nuka system.

KIM: I love Darrell.

BRYCE: He's great. Yeah, yeah. And he says, you got to get up there. You got to get up there. And for all the other reasons, too, I'd like to get to Alaska. But I've yet to make their conference. But I will tell you, I've been on virtual webinars and their virtual conferences that they had during COVID. And a lot of what we tried to implement here, again, siloed, was what we were learning out of the Nuka system of care up there. And I can tell you, if I had a wish list, the only gap that we've got from the NUKA care system is we've yet to hire social workers on our team. I'd love to have that in on the team, but that's the only real piece that I would say we lack at the moment. because again, in working class folks, I mean, there's so many resources and things that we could tap into, but we just either we don't have the time or we don't have the knowledge, you know? And so that is exactly what led us down this kind of pathway of advanced primary care and making it to where all these care providers, it's a patient-centric care team taken from Nuka. Yep. And it truly has no misaligned financial incentives at all.

JOHN: So we've had the Nuka folks and it's customer centered. Remember, it's not patient centered. They don't even call it patient.

BRYCE: Yeah, customer, that’s right.

JOHN: I agree with Kim and you, Bryce. We all, we're big fans of Nuka here at Moving to Value Alliance. And so the remarkable, and I believe very replicable model. And they own a hospital. And as you know, which is kind of shocking, because as you guys know, and I could say it as a former hospital president, hospitals are part of the problem, not part of the solution. But they've managed to do it with even with the hospital. But yeah, no, thanks for bringing them up Kim.

KIM: And your social worker point, Bryce, just building on that, John, is exactly one of my base moves when I was working solely in value based care and with ACOs was I understand that you want to hire more nurses. Have you heard about social workers? And watching what would happen when social workers entered the mix and how the clinical teams, you know, all of a sudden are like, oh my God, I feel so much lighter. I can focus on the clinical aspects of what the person in front of me needs and this knitted together social fabric, right? We haven't done it. We've separated it from people.

BRYCE: Yep. And I can tell you again, if you have us on a year or two from now, again, I think I'll give you a different report that we've got social workers.

KIM: Very cool.

BRYCE: So it's definitely a goal here. And too, I just want to add one other big win and for the community is we were able to recruit through through quality, safety and appropriateness data, we found that the highest quality orthopedic practice in Ohio was about 90 minutes from Ashtabula down near Akron. And I want to say three years ago now, I was able to convince — and again, back to social capital, just because I know you guys understand it, but maybe somebody listening doesn't really see how far this goes. But I reached back out to my friend Tom Campanella that ran the healthcare MBA program. And I said, Tom, I think the CEO of this orthopedics group called Crystal Clinic down in Akron went through our MBA program. Could you make a personal introduction to Dan and I? And I got Dan on the line. We did a direct agreement contract for all of our plans with Crystal Clinic for all services, all things. And not only that, about three years ago, Crystal Clinic opened a brick and mortar right here in the eighth poorest county in the state of Ohio, right across from the main hospital. And they run full, if they don't have the, you know, maybe we don't have hand and wrist specials, they'll at least run one up here once a month. Spine doc, we have full orthopedics right here in Ashtabula. And again, procedures, now they're going to be done down at their ortho hospital. But no one even thinks twice about it, going down to their state-of-the-art hospital and not having to pay a dime or worry about the outcome. It's so cool. I mean, it really, yeah, it's super cool.

DONOVAN: Bryce, you're doing fantastic work. I certainly can appreciate the amount of effort it takes to build those coalitions. So I'm curious, though, you know, in certain areas, the politics can be interesting, especially when you're dealing with municipalities, so many different stakeholders. Tell us about some of the friction points that you've experienced along the way in this journey.

BRYCE: Yeah. So you are spot on, my friend. The city manager here serves on the hospital board of directors.

DONOVAN: Yeah.

BRYCE: And so he had a real hard time. He had to walk into one of those board meetings and said, hey, we just fired our BUCAH insurance program here. And we're going to this Health Rosetta model that rewards our patients around quality, safety, and appropriateness. And we're going to have DPC. And so this is going to impact the hospital. And I'm just letting you all know, this is the decision I've made to do it. And I can tell you, he drug his feet for quite some time. He did not want to have to do that. This is wild, Donovan, that you even asked the question. RosettaFest, I think two years ago was in D.C. At that event, I brought the city manager, a county commissioner, the community pharmacist, and maybe our DPC doc. I'm trying to remember. We had a panel that we spoke at. I happened to just review it the other day because I needed a quote out of there. The city manager didn't realize it then. And I don't think any of us now then realize it. But the Consolidated Appropriations Act, fiduciary duty — now it doesn't necessarily take that long dragging of feet for them to make the right decision because he said it in that. He said, my son just got injured on the football field. He said it was so nice to have a concierge nurse, Nurse Cindy for them. Nurse Cindy answered the phone. I'm a panicked dad. My son's leg is sideways. Where do I go? What do I do? You know, and here we go. MRI, we're going to get you right in VIP style with the ortho clinic, boom, boom, boom. And in that final thread where he was speaking on stage, he said, I have a fiduciary responsibility. I'm dealing with public funds. We need to be going for the best place for the best value, price and or quality. No qualms about it. I don't have a choice. We have to do what's right. And so it's almost like an epiphany going —

LISA: It’s like, what a novel idea, huh?

BRYCE: Yeah, what a novel idea. Yeah, and I'm saying to you all, the CAA and this fiduciary duty now, it's forcing the hands of people who would much rather push the easy button in years past. Now they have to take action or they're going to be found held responsible.

JOHN: Yeah, you know, we thought, Bryce, when the CAA was passed in 2020 and acted in early 2021, it's been more than five years now. I think some of us thought, oh, this is going to change everything immediately. And I remember being a little skeptical myself, thinking, I'm not sure the average employer is paying attention to federal law and even know what it means. But I think your point now is once you tell the employers, hey, you know, by the way, this is the law and it's your responsibility. And I've always said the other, the second part, and as a former CEO of a billion dollar hospital with $50 million, I think, healthcare spend for my own employees. It's kind of all of a sudden you have the epiphany as an employer say, wait a minute. I knew how much I spent on toner and ink and paper to the penny so I could shop it at Staples or, you know, WB Mason. But I had no idea how much I was spending on MRIs, hip replacements for my own employees. And it's the second largest expense in my billion dollar budget. And it's crazy how even — and I'm in the business. I was in the business and I wasn't paying attention to it. So I think once you confront employers with that — and I think just to comment on your health committee, I love that idea because CHROs, and we've talked about that here, they're poorly equipped and trained to deal with this and they're reluctant to change anything anyway, as you know, when the CFO is looking at it just financially, I think the idea of a health committee, especially with unions, unions are the ones who are getting screwed, I hate to use the term, over the last 25 years, right?

BRYCE: Yeah.

JOHN: Because they'd rather get increased wages and their companies would rather expand their businesses as opposed to paying increasing health care expenses. I love all that. So let me shift the whole conversation, Bryce, for a moment. So, you know, we're Moving to Value Alliance. So value is quality over cost, right? You've certainly talked about changing the cost landscape and lowering the cost environment. And you've improved access for your people in your community. No doubt about it on that front. What about some, you mentioned gaps in care. What kind of quality outcomes do you monitor or if you do at all?

BRYCE: It is perfect timing that you ask this question. And again, I don't know how all these things just happen to be. But this week, we're working with Health Rosetta, co-founder Sean Schantzen and team because they are our data warehouse and they have been from the very beginning. They have five, six, seven years of claims experience and all the detail that we need. We do request, you know, from our DPCs, we do quarterly reporting. And then obviously nurse navigation. We've got every ticket, every deductible waive. We've got all this aggregate data. Don't know if you guys have had Dr. Scott Conard on here yet. You guys know him or of Converging Health?

STEVE: For sure.

JOHN: Scott's a friend of ours.

BRYCE: Okay, super. So we've kind of partnered with Scott. We love what he's doing with Converging Health. And so our Rosetta team, ourselves, we are actually looking to put all of this, because I think we may have one of the longer COHP studies, but the last five to seven years aggregating all of this data, using Scott as his system as help in gaps in care and basically measuring risk movers. You know, have we taken his quadrants and reduced lightning strikes to chronic conditions? And so we're currently working on that right now. Like it is our goal to have it by the end of summer that we have an actual report and it may be published ready to go. Exactly what this program overall has done for health outcomes, financial costs. And again, on a handful, a few thousand people in a small community, I would love to report back to you when that's through because I think it's gonna tell us all. We have everything but in quarterly and annual reporting, but this will put the aggregate on it all.

JOHN: I think once you roll that up, you're going to have a seminal paper there.

BRYCE: We feel it. We feel it too. And I'm really excited. I'm really excited for it.

KIM: Well, and picking up on that exact point, you mentioned earlier about the importance of independent clinicians and pharmacists, right? That independence, we know from the meta research on better outcomes at lower cost, independent clinicians produce better outcomes at a lower cost consistently. So hearing that you're feeling that that seminal paper is going to only add to that evidence. And I feel it too. I believe everything you're saying and know that the outcomes will follow because it is the pattern we see with independent clinicians and communities. My question is, what do you think it takes to get the supply side of the equation, the clinical side of the equation, ready to meet this moment and this demand from patients and communities?

BRYCE: It can be difficult.

KIM: For sure.

BRYCE: I'm experiencing that right now with an engagement in Maine, in a coastal town in Maine. Again, you've got providers, physicians, others who've worked in the fee-for-service business, have been employed forever. They have a hard time seeing this. They can't believe it. There's doubt. I mean, every obstacle or barrier we've dealt with, I was up there trying to recruit a DPC doctor just a month or so ago. And I can tell you, it is tough. Sometimes it's a year or two. I can tell you, did that in West Virginia years ago, and it was so hard to even get our first DPC down there. But I think that a lot of providers are getting burned out. They're ready to make a change, and whether financially they're ready or not, you know, they're to a point where it's just like, I'm ready to take the risk. I'm ready to move away from this god-awful sick care system that I'm in and can't seem to get out of it. You know, I mention it often when I speak, but Robert Pearl's book, Uncaring, changed my world. I'm not even a clinician, physician, but I read that book and I still remember being on a flight and I had tears coming down my eyes reading that book, like, man, you know, family physicians with these high suicide rates. And I just can't wrap my head around it. So I came back. I remember telling my kids, do you guys have any — you know, my son's, you know, 15 today and my daughter's 11. I said, what about being a family doctor? Would you guys, would that interest you to help people? And, you know, and they have an understanding a little bit of what I do, but I, every time I'm around young people, I just promote the heck out of family medicine. We do a scholarship fund here with — I chair a foundation in town. And we give four scholarships last year. And at the banquet, I spoke to the four winners. I said, please tell me somebody here, you know, you guys have a goal in mind, maybe coming back as a doctor here to this underserved community. And, you know, you could do such great work. And two of the four said, yeah, one plans to be a doctor. The other was, I think, a radiologist in mind. And I'm just like, you know, come back here, serve the population where you grew up, you know, make an impact. So it is, it's tough without a doubt. There's a, you know, a lot of work that goes in bringing people into it.

KIM: I love that you are doing the ground game work to talk with people because I've experienced that and have friends and colleagues who are those family medicine doctors who for their own sake had to leave hospital practice because it was burning them out, right? And the most succinct phrase I've heard is the current system, the 20th century healthcare system we still live in, it's rigged against the most generous. And what I hear you talking about is resetting the table with the community, right? With those clinicians and patients at the center, I think there is a ton of hope there. And I'm seeing it too, where med students and residents are saying, my goal is independent practice. My goal is not to stay within the system where I'm held to 15 minute appointments. I know that isn’t the best care and I know that that is going to fry me as a human.

BRYCE: Yep, absolutely. In this DPC membership model, financial model, you ask any DPC that we have brought in anywhere in the country, their lives are better. Their financial, you know — on average, our DPCs charge $75 to $90 per adult per month. And if their patient panel is five or 600 patients, multiply that out. They're making double the money. They have more time on their hands. They're providing, they're practicing at the top of their license. We have DPCs in Kansas that deliver babies. I mean, how cool is that?

LISA: And they don't have the administrative burden.

BRYCE: And no administrative burden. Right. Yeah. Like every resident in America, they need to hear about this model because it's — don't sign your life away, don't go work for the medical establishment. Go do good work like this.

JOHN: You know, Bryce, before we wrap up, as a former residency program director, if you haven't, I would urge you to get in touch with the family medicine residency programs in your geographic area and figure out a way to sponsor a rotation, a clinical rotation through some of your sites, because that's often what kids need to see. And once they see it, they go, wow, this is pretty cool. I could work here as long as I have some kind of income guarantee starting out of the gate. Because they all have, as you know, a quarter million dollars or more, half a million dollars sometimes in debt. I think that would be great. I'm guessing you've already done that.

BRYCE: Yeah, I have not. It's a great idea and I would love to.

KIM: And I couldn't agree with you more, John. I mean, I've got a friend in Kansas who is part of their family medicine training program. And she is holding out because she is an independent family medicine practice. And what the residents say is, I can't be it if I can't see it. If all of my teachers are hospitalists, I don't know how to go into independent practice. So your point, John, is spot on.

STEVE: I hate to draw this to a close, Bryce, because we can keep going on. You've inspired the group of us. You know, thinking about your story, you've built something very unique, really close to home. It's now spreading east and west and south and north. I think if I could speak on the behalf of my colleagues, what we'd like to do is AI clone you for another 100 or 1,000 Bryce Heinbaughs, right? Because we do need your model, but there's only one Bryce and it's got to grow. And maybe the RosettaFest is a vehicle for that. But for our listeners now, we'd like to finish — we've had all sorts of guests from different perspectives and stakeholders. But, you know, paint us a picture of what you think health care is going to look like from your view in the next three to five years. Are we going to have expansion of these communities? What is it going to look like for working families and for the future of health care in general in America and how this takes hold?

BRYCE: Yes, absolutely. I'll say right now, our largest focus for the next two to three years that we're seeing is cash pay and direct pay opportunities. Employers are really wanting to participate in this, providers as well. But cash pay and direct pay, because of the hospital price transparency rules, and finally we're getting traction here, we are doing more around this today than we ever have, and we're only scratching the surface. We are working with TPAs that their entire mindset and the foundation of their systems are going to be for cash pay, direct pay. And I see that as a really big deal because if you can put the quality, you can lead with quality, safety, and appropriateness, we've got a high value provider who also is willing to take a good, reasonable, fair price. Let's again, remove the BUCAH, remove all of this in between, pay them quickly. It's, you know, paid within either same day or within seven days. Man, everybody, everybody's happier. The patient obviously wins in that scenario. But I think that's, that's a big next few steps. And, and I'm — we're all obviously on the edge of our seats around AI. I don't know what to tell you guys in terms of our model, our, our future. I can tell you what we're seeing in claims experience and claims trends right now is scaring the hell out of us because of AI in the exam room, never seen coding and billing so — it's ramping up, I think, faster than actuaries, than any of us in the leadership roles in this industry have realized. And we're not quite certain how to exactly fight back on that. And that's scaring all of us right now.

JOHN: Good point. You know, Bryce, thank you. Let me just say in closing, thank you so much for joining us. You've inspired us and given us a lot of thought and food for thought. And hopefully, we've given you a few things that can help. I think your model, though, I'm thinking back to your comment about Scott Conard, and we've had Scott on. And just remember, Scott's practice was basically improving the health of their community, keeping people out of the hospitals, moving them to outpatient facilities, and the hospital in town bought the practice and then shut down that operation because it was hurting the hospital. And the reason I bring that up is because your model really does work better in more rural, more community-based areas, because the big hospitals like I had one, you know, we're going to do everything we can to combat guys like you and what you're doing. And I hate to say it, but that's the reality.

BRYCE: I remote start my car most mornings. He says, he said, Bryce, just whether it's hot out or cold out, remote start, make sure that thing doesn't explode.

JOHN: That sounds like, that sounds like Scott. Well, Bryce, thank you so much for joining us today. And I want to thank my colleagues for a great conversation. And it's really been a pleasure having you on. And have a great rest of your day.

BRYCE: Thank you all very much.

JOHN: To learn more about MTVA and how to join our community, visit our website, movingtovalue.org. If you enjoyed this conversation, please follow us and leave a review on Spotify or Apple Podcasts. Thanks again for listening and for being part of this important movement.

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