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Unfinished Business: An Expert Perspective on NC’s Healthcare Safety Net

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This week’s blog is from Randy Jordan, our Chief Advisor for Impact for Health. Randy is a nationally-known community health expert and thought leader who is committed to strengthening and improving healthcare systems, while ensuring that every individual has access to high-quality care. 

At the opening of a recent Next Stage staff meeting, the team was asked, “What’s some unfinished business in your career?” After getting over the surprise of such an important question being asked in the icebreaker slot, my answer came immediately to mind – sustainable funding for the safety-net.

My Background

A brief explanation and some background are needed. My professional life began as a pharmacist in a small Florida town where most of my customers were on Medicaid. Even with a Medicaid card, the cost of prescription drugs was a big barrier to my customers receiving their life-saving medications. I did all I could through the use of generic drugs and drug substitution to help them stay drug-compliant, but it was an uphill climb. Why? Because the nature of pharmacy practice was rapidly changing. Local pharmacies were increasingly carrying the banners of large corporations and the prescription drug benefit was more and more controlled by specialized pharmacy benefit managers and mail-order pharmacies. At the same time, drug prices were beginning to skyrocket. My ability as a healthcare professional to influence affordability questions faced by my customers was diminishing day by day.

Healthcare is a Business Opportunity

A version of this story was repeating itself in the lives of other health professionals as the transformation of healthcare from a healing art to a business opportunity began to impact doctors, dentists, nurses, physical therapists and mental health practitioners to name a few. Institutional healthcare providers like hospitals and nursing homes were not immune and faced similar pressures. The last 40 years have been marked by the economic realities of increasing health costs colliding with an elusive desire by healthcare providers to preserve the quality of rendered services.

Sadly, the data from other comparably developed countries suggests that we are losing the cost vs quality battle in the United States. According to a recent Commonwealth Fund report, the United States ranks last among 7 industrialized countries on measures of quality, efficiency, access to care, equity and the ability to lead long, health, and productive lives despite having the most expensive healthcare system.

And, who is really losing out? Underserved, uninsured patients who have been largely left behind in the wake of our country’s healthcare economy.

The growing interests of Medicare, Medicaid and commercial health insurers in transitioning the underlying principles of healthcare to a value-based model have piqued my interest in capitation (fixed per member per month payments) as a provider reimbursement mechanism, especially for healthcare providers dedicated to serving underserved populations. Again, you might ask – Why?

A Capitation Case Study

In the 1990’s, I was a healthcare lawyer specializing in provider risk-sharing arrangements for managed care organizations. I learned from that experience that whoever bore the risk of providing healthcare to a population controlled the way healthcare was delivered. With escalating healthcare costs, health insurance was the dominant player. Capitation was tried and largely failed because of an over-emphasis on cutting healthcare costs at the expense of quality.

In the early 2000s, I shifted to working in the international healthcare space and helped establish 2 charitable hospitals and 3 free clinics in Cambodia, one of the poorest nations in the world. At the time, there was no health insurance in Cambodia and healthcare providers had to make their fixed, global budgets work to continue to serve their patient population. This was a form of capitation surfacing in an unexpected place with a unique twist. The twist was that healthcare in Cambodia was operating with a low-cost structure – allowing providers to adjust their budgets in a way that balanced cost and quality. Amazingly, I experienced hospitals reaching break-even within 5 years and reinvesting their profits into other needed services to benefit their patient population.

So what about today?

So what about today? I’ve found that North Carolina’s informal safety-net system of healthcare could be an unexpected asset as we strive to achieve the benefits of value-based care. A simple equation helps to illustrate the point: Healthcare Value = Quality divided by Cost.

In the case of safety-net providers, their fixed annual budgets require them to squeeze out excessive costs and maximize the use of their limited resources. As a result, the cost of primary care services among federally qualified health centers is about 75% of the cost of the same services provided through traditional healthcare providers. Among free and charitable clinics, the cost savings are even greater at approximately 50%. Thus, the cost feature of the equation tilts in favor of the safety-net. Quality measures compare favorably too. Comparative quality outcome measures reported by FQHCs and free and charitable clinics are year-on-year on par with or better than the outcomes reported for providers paid through commercial insurance. On the value-based care tally sheet, safety-net providers tick many of the boxes.

Capitating the Safety-Net

When all of this information is taken into account, I’ve found that safety-net primary care providers are ideal candidates for capitation-based reimbursement. It seems counter-intuitive because the safety-net is thinly funded and capitation shifts all the financial risk of providing care from the health insurers to the providers. But, I’m convinced that the safety-net system of healthcare represents a model that provides many advantages: escalating costs are moderated by safety net providers having a history of living within their means and quality performance measures are enhanced because the control of practicing healthcare is placed in the hands of those most highly trained to improve health outcomes.

For me, this remains a bit of unfinished business. If you too are interested in pushing a bit further the idea of seeking sustainable funding for the safety net, feel free to reach out to me at Next Stage – randy@nextstage-consulting.com.

Why Nonprofits Don’t Need the Biggest Audience

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I’m fascinated by the origin stories of social movements. They are as varied as the people who make up their constituencies. Civil Rights, the fight for marriage equality, the Labor movement, women’s rights, abolition, anti-war demonstrations – these are just a few of the most prolific movements that have shaped our national narrative.

It’s easy to imagine that these movements had traction and noteworthy leaders from the beginning. In reality, most simply began in living rooms or at kitchen tables, finding more followers as their message spread.

When I meet with nonprofits about marketing, I regularly hear concerns: their lists aren’t big enough, they need more constituents, they are worried they can’t compete with the bigger, more established organizations. And while a greater following is the goal of any cause, there is a lot to learn from the history of national movements that also started small.

It allows you to test what works

There’s a lot of pressure on organizations to be ‘the next big thing,’ be more creative, find that magic thing that will go viral and create a mass following. In most cases this isn’t reality – and it isn’t even helpful.

I recently worked with a nonprofit on a digital campaign that launched some big ideas for their organization. Before the campaign, we noted that the marketing list was smaller than we’d hoped but it was a highly-engaged group that had intentionally opted in. We used the opportunity to develop high-quality content and messaging for the year. The email series was opened at a rate of more than 75% over two months. Despite the smaller list size, it enabled the nonprofit to build valuable content, test what worked and develop a longer-term plan for the content without the pressure of a giant following.

Building and testing over time allows you to develop stronger, more iterative marketing that speaks directly to your audience. 

It fosters authenticity and relationships

Successful movements happen for a combination of reasons, but one common factor is the sense of belonging they build among members. It’s up to nonprofits to build this same sense of comradery and authenticity among their constituencies. We’ve talked before about the expectations of younger consumers and their desire to establish a more relational stance with their favorite brands – and many consumers will now walk away from brands that conflict with their own identity.

Authenticity stands out amid campaigns that aim to be ‘the next big thing.’ Money can certainly buy ad space – but it’s not a replacement for a real relationship with your audience. It’s the latter that cultivates understanding, passion and ultimately – movement.

It builds a strong foundation

Every social movement that rose to prominence began in a small community. One of my favorite examples of this is the MeToo movement. The phrase was coined in 2006 by activist Tarana Burke but didn’t gain national attention until 2017 when actress Alyssa Milano encouraged people to share their stories of sexual harassment on social media. Ten years before ‘MeToo’ gained prominence in the media, it lived as a phrase of empowerment among women in smaller pockets, gaining traction over time. ‘MeToo’ isn’t alone in this phenomenon. Community activists and leaders often start small, building recognition and engagement over time – until something prompts a critical tipping point.

The “slower” start enabled the MeToo movement to create a strong, meaningful foundation. By the time it went national, the phrase already had a clear identity and devoted base of followers.

It’s not bad to want a big audience of raving fans. Some of the biggest social movements in our nation’s history only happened because they captured our collective imagination and attention. And ultimately, reaching a critical mass of people is what will spread important messages far and wide.

But just as social movements don’t begin with a big viral moment, your work likely won’t either. The ability of nonprofits to build small, committed audiences with deep understanding and motivation is a superpower. If you’re doing the hard work of daily movement-building and aren’t feeling the traction just yet, don’t give up.

Movement-building is a long game – and it can change the world.

Inside Out is the New Bottom Up

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Hearing the words “bottom up” when we look at how people are viewed, judged or measured can be a trigger for me and others. In my lived experience, I’ve witnessed negative connotations or biased opinions when it comes to the reality or perception of what the “bottom” references.

The Study that Put Charlotte at the Bottom

When the 2014 “Land of Opportunity” Study placed Charlotte 50th (out of 50) for economic mobility in major cities, stating that children born into poverty likely remained in poverty, there were shock waves. The findings were a catalyst for rallying cries from corporate, community and civic leaders to do something to change this outcome for Charlotte. Leaders joined forces and organized the Charlotte-Mecklenburg Opportunity Task Force, ultimately developing 91 recommendations to improve and advance economic mobility, especially for the most vulnerable populations.

That study was published a decade ago. Since that time, Leading on Opportunity, an organization supporting Charlotte’s generations-long journey, was formed to convene sectors, implement the recommendations, and improve economic mobility for all using three cornerstones: strategy, data, and policy.

Reactions to this study sent a clear message – Charlotte didn’t like being placed at the bottom but it ended up there from its inability to improve the quality of life for many of its citizens.

How it Feels

Most parents want their children to thrive in their educational pursuits – from preschool to advanced degrees. This belief is strong and crosses variables of race, religion, gender, zip codes and economic status.

When my younger son was in third grade, he struggled with reading and spelling. He would try really hard, but for him, success was not instant. My son was not a traditional learner but instead an experiential learner. This means he learned best through a hands-on or interactive approach strengthened by experiences. Yet, his teacher at the time was not enthusiastic about experiential learning or the context of how he learned. Therefore, my son was placed in the lowest reading and spelling groups. One day, he came home and asked, “Am I smart?” Even in third grade, my son, who learned differently, knew that he was at the bottom. And more importantly, he didn’t like how that made him feel.

In response to his question, I shared that sometimes it takes longer to process, navigate and understand information. I told him that we would find the right tools and resources to course correct to get him on track. It was a journey of advocating for experiential learning not only for the teacher, but for the school administration as well. I did not shy away from this journey because I knew the talents and gifts that my son possessed. I just needed his learning environment to adequately adjust to how he learned and processed information.

After months of sharing case studies and articles on experiential learning, I gained buy-in from the principal who directed the teacher to try this approach. Once she did, my son gained traction of clarity and understanding that was notable in elevating him to higher reading and spelling groups. This was a pivotal moment that changed his trajectory and mine.

Who Decides?

What occurred with my son are common occurrences for many. Someone is deciding who is deemed to be “at the bottom” – not only in education, but in a variety of sectors and situations.

When we work on projects at Next Stage, we regularly hear the phrase, ‘from the bottom up.’ Usually this is said with good intentions and acknowledgment from people in positions of power or influence, especially for problem-solving.

But let’s be clear – no one likes to be at the bottom or feel less than. This is evident in Charlotte’s response to the study and my son’s response to his teacher. There are structures and systems put in place that don’t optimize inclusivity or equity for everyone. And while “starting from the bottom up” implies that everyone will be able to provide feedback, it also implies that the final decision will still be made by those at the top. This begs the question:

Who determined the bottom? And who is benefitting from that structure?

Unpacking the Inside-Out Framework

It’s why Next Stage has changed its language over the last year. We champion an “inside-out” approach instead of a “bottom up” framework. “Inside-out” focuses on proximity to a problem or concern, seeking resolution together. It shakes up the process and suggests that every stakeholder’s voice has value, regardless of where they reside in the community or organizational chain of command.

We want to continue this conversation and continue leading the charge on reframing this mindset. On April 17, Next Stage is launching a series of free webinars unpacking the concept of “Inside Out”. We’ll share how Community Voice creates a foundation for nonprofit leadership, communications and program staff to authentically engage with stakeholders, improve program quality and create messaging that resonates.

The first session will be on Wednesday, April 17, at 11 am. Sign up here to join us!

Igniting Change Through Movement-Building Marketing

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Movement Building Marketing: A Real-Time Case Study

At Next Stage, we talk a lot about movement-building marketing. And while you won’t find this term in marketing textbooks, it’s a hallmark of great nonprofit marketing campaigns. 

For many years, nonprofit marketing has focused almost exclusively on acquiring donors, event participants and volunteers. These are important goals and key personas for any organization that wants to make an impact. The challenge is when organizations get hung up on the what of their mission, focusing almost exclusively on service offerings or donor campaigns. 

Movement-building marketing focuses on the why of a nonprofit’s mission, inspiring action and engagement. It’s more than selling a program – it’s inviting people into the story.

Own Your Journey

Over the last year, Next Stage has partnered with The Center for Community Transitions (CCT), a long-standing nonprofit that supports justice-involved individuals and their families. Its programs are designed to support currently and formerly incarcerated people and their loved ones as they rebuild their lives. 

To celebrate its 50th anniversary, CCT aimed to build a year-long marketing plan to build its constituency and help launch its vision of a second chance city. 

It was important to CCT to build a campaign that fuels not just action – but also understanding of the criminal legal system and how it impacts culture. “We are so often focused on the ‘doing’ that we miss out on the ‘being,” said Patrice Funderburg, Executive Director of CCT. “Our goal is to encourage a pause for awareness and deeper conversation. We believe this understanding will lead to impactful action.” 

It was also critical to the CCT team that the lived experiences of their stakeholders were centered throughout the process. Every element of the marketing plan, from landing page images to email content, was built to reflect true experiences of an impacted individual and how those experiences relate to the bigger picture. It’s an intentionality that we believe sets this campaign apart. 

The first phase of the campaign launches in March with The UnLearning – a month of content that includes weekly emails and live social media conversations. The content is designed to connect participants to the big picture issues of justice involvement, while reflecting on their own relationship with the criminal legal system.

Follow Along

Our team is proud of this campaign. We believe CCT represents an authentic approach to movement building marketing. Follow along by signing up to watch this campaign unfold over the coming months!

The Data Won’t Save Us: Human Insights for Social Change

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The Data Won’t Save Us

I’m a self-professed data nerd. But there are long-held data points that have been repeated so many times that they have become conventional wisdom – or even tropes.

We plan for future prison capacity based on third grade reading rates. Source
Only 3% of youth exiting the foster care system will graduate college. One in five will experience homelessness. Source
One-third of children who grow up poor in the U.S. will experience poverty as an adult. Source
If your city has low economic mobility, it is nearly impossible to escape poverty.

If you’re plugged into any conversation about social innovation, you’ve heard these numbers, and many others like them. They are breathtakingly, shockingly awful – a stark report on the reality that many nonprofits, activists and community leaders live every day.

I think most of us like data – even if it is hard to look at – because we can make sense of it. Numbers can be studied and improved. We perceive that the ‘answers’ can be found in those numbers. And while data is driven by a desire to know more and do better, I wonder if it sometimes stunts our collective curiosity.

When I pause to consider what’s behind the data, I start to wonder: 

  • At what point does data become a self-fulfilling prophecy? How do we use these numbers to guide us rather than allowing ourselves to fall into resigned acceptance? 
  • In using data to make sense of complex issues – do we also use it to distance ourselves from the complexities of being in relationship with people?
  • How can data inspire us to imagine something new – instead of simply to predict an inevitable future?

Quantitative data is critical to the work of social good. We need it to shed light on issues, to help evaluate the effectiveness of programs and to galvanize us to action. But the temptation exists to bury ourselves in that data, to seek the answers in clean numbers and next steps.

The data won’t save us – but it can point us in the right direction.

Let it guide us towards relationships.

Data is a great starting point, but it’s no substitute for lived experience. This is one reason that Next Stage so strongly advocates for qualitative data. The data often tells us where to look – but how and why are most often rooted in conversations with people most proximate to the issue at hand. These relationships are where trust is built. And trust is where long-lasting social innovation starts.

In our report, Inside Out: The Case for Community Voice, we shared a story about a nonprofit’s mobile health unit. The unit nestled in a few locations before centering itself at a local community center. They saw very little traffic, even though the numbers suggested that this would be best supported by a mobile unit. But when the driver of the mobile unit walked into the local 7-11 and struck up a conversation with the owner, they found that the convenience store was a trusted ‘third space’ for that community and saw a lot of daily traffic. The manager offered the parking lot for the mobile unit once a week, the team accepted and use of that unit increased significantly – all because of a partnership rooted in a simple conversation.

Let’s embrace the tension.

Working on any social issue is messy and rife with competing viewpoints. It can be tempting to lean on data that feels straightforward and ‘clean,’ when conversation feels messy. The reality is that every data point represents a real, complex human with a specific viewpoint. 

Our team learned this firsthand when we did work for TreesCharlotte. Charged with developing campaign messaging, we pulled from data and our own common beliefs to develop a message we thought was obvious – ‘Everyone loves trees.” When we workshopped this with our focus groups and stakeholders, the dissent was immediate and overwhelmingly more complex. It turns out that not everyone loves trees. They sometimes fall on houses, are expensive to maintain and have impacts that are out of our control. We changed the message to a more nuanced expression, “Everyone has a tree story,” but if we hadn’t been willing to engage the tension – and the disagreement – our data would have led us far astray.

Let it inspire us to imagine something different.

Rather than self-fulfilling prophecy, let’s allow those sobering numbers to help us get curious. The temptation to bury ourselves in the research is real, but so is the risk. It’s easy to forget that the data isn’t inevitable, and that we have the ability to imagine something different for ourselves.

Our team recently collaborated on a documentary about Southside Homes that featured highly proximate organizations, including ParentChild+.  In the documentary, NC State Director Angela Drakeford speaks to the need for imagination and action when she states, “We have all the data we need. We don’t need to waste ten, twenty, thirty more years on data – then the ten, twenty, thirty years of people that contributed to that data, it’s too late to save them. I think we have enough now to think outside of the box. Let’s kick those boxes over and let’s make a difference in this community.”

Next Stage Celebrates 10 Years with The UnFundable Project

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FOR IMMEDIATE RELEASE: February 9, 2024

Next Stage Celebrates 10 Years with The UnFundable Project

[Charlotte, NC]: Yesterday, Next Stage celebrated its 10th anniversary by announcing the recipient of The UnFundable Project, a $10,000 grant. The award used the philosophy of trust-based philanthropy to identify a project in the Mecklenburg County area that would typically be deemed “unfundable,” determined by a panel of community leaders.

The $10,000 grant was awarded to Caroline Calouche & Co., a local arts organization that creates memorable dance and circus arts shows. Their application requested funding to pay off a credit card that was used to replace their damaged sprung floor.

“The UnFundable Project launched from a desire to highlight the importance of trusting nonprofits and the people who make them go. We believe in the importance of relationships, knowledge and proximity to issues and constituents. We believe this makes nonprofits who already have trust built in community best equipped to determine how to make an impact with the resources entrusted to them,” said Josh Jacobson, CEO of Next Stage.
The award is a celebration of Next Stage’s 10 years of social innovation work, a significant milestone for the company on its mission to build belonging at the intersection of social good.

“Next Stage has gone through a lot of evolution over the years, and we have arrived at a central value proposition, of building belonging at the intersection of social good.” says Josh Jacobson, CEO and Founder of Next Stage. “We believe that there is no way forward but together.”

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About Next Stage: Next Stage is a social innovation company that consults locally and nationally for nonprofits, private sector companies, government agencies, faith institutions, philanthropy and community leaders.

Next Stage is a respected thought leader on the themes of Community Voice, profit and purpose, and social innovation. Notable achievements include partnership on Spark Centro, making the case for Community Voice, and releasing a respected weekly newsletter on all things social good.
To learn more about Next Stage, visit its website.

Contact:
Janet Ervin
Chief Marketing Officer
Next Stage
janet@nextstage-consulting.com