HealthcareExpanding Access to Care for the Most Vulnerable Populations

Ryan Dewey Smith is the Founding Executive Chairman & CEO of Inperium, a nonprofit supporting organization that helps human services providers scale sustainably while preserving their mission and identity. Known for his pragmatic approach to leadership, governance, and organizational growth, he has built one of the nation’s largest constellations of mission-driven health and human services affiliates. Ryan is also the author of Sustaining the Mission, a forthcoming book on building durable nonprofit organizations through disciplined strategy, infrastructure, and long-term stewardship.

Picture your home community. Now picture a family living in it: two loving parents who grew up poor and, lacking access or support for higher education, have spent their lives working minimum-wage jobs that don’t offer health insurance; he works two part-time jobs; she works as many hours as her role as the primary caregiver to their two children allow her; their nine-year-old daughter has a rare genetic disorder, is nonverbal, has numerous severe disabilities, and is occasionally violent; their eleven-year-old son is regularly bullied at school and is struggling academically; their landlord sold the small house they had rented for years, and unable to afford current rent structures, they have been living out of a camper for six months; because of government funding cuts and a grant application that was denied, the center they turn to for daytime assistance for their daughter has reduced operating hours and has curtailed respite services. These are just a few of the facts of a real family from Aurora, Colorado. Their individual circumstances are unique to their family, but the pattern of vulnerabilities they demonstrate are not uncommon. If you looked, you would find similar stories in your home community, no imagination necessary.

What might be required to change, even minimally, the arc of such a family’s life?

The demands placed on the nonprofit human services sector continue to grow while funding sources shrink. The 2020s have been particularly volatile, with a great deal of overarching economic uncertainty, waves of inflation, donor fatigue, increased governmental scrutiny of programs, and shifting political visions of government’s role in supporting services for vulnerable populations. Such economic, social, and political volatility arrives in a climate where individuals feel volatility of a different sort: more individuals seek out mental health assistance, more families lose access to stable housing, more parents discover that their paychecks have not kept pace with the cost of the products and services their disabled children require. Read the headlines on any given day and there is ample evidence that a slowly unfolding crisis stretching to the end of the last century continues. The magical arrival of help nonprofits have relied on for decades isn’t likely and isn’t a stable solution if it were likely.

Nonprofit organizations serving these vulnerable populations must think in new and innovative ways if they are to move beyond survival and toward sustainability. When resources are finite, greater efficiency is a requirement. The nonprofit human services sector must borrow an approach the for-profit world has excelled at: the development of scale. Small-scale nonprofits don’t have the capacity to expend limited resources when the cybercriminal holds their data hostage, their archaic, time-consuming payroll software crashes, or a litigious individual armed with misinformation found on social media files a lawsuit. They deserve unfettered access to professional staff to provide the services their organizations require to fulfill their missions. By joining together, nonprofit providers can benefit from shared services cost efficiencies provided by highly sought-after experts instead of hoping that they can find a kind-hearted IT expert, accountant, or lawyer willing to work for a fraction of their value because they believe in the organization’s mission. Creating scale through shared services models cannot only reduce a host of business expenses, done right it can aggregate capital, expand subject matter expertise, and create opportunities for peer learning.

Shared-services models allow nonprofit human services organizations to maintain their local identity and community relationships while gaining access to resources such as technology, compliance support, staffing infrastructure, and emergency funding. Enterprise software not only doesn’t care whether it is producing paychecks for 4,000 people or 40, it offers data analysis that allows organizations to track expenditures and revenue and model the financial implications of proposed programs before they exist. Shared services can not only provide the paperwork required by employee insurance programs, they can consolidate insurance offerings across multiple organizations to bring down rates. As discount stores know, the ability to purchase in bulk reduces the cost per item, a fact that’s true even when the items purchased are disposable gloves for substance abuse program providers, assistive technologies for disabled individuals, or oil filters for fleet vehicles.

In affiliation models, when the federal government abruptly announces a ninety-day hold on reimbursement payments for counseling services or a state government shutters offices during a budget impasse, a robust network has the financial ability to carry organizations in one service sector or within an impacted state until funding stabilizes. They can provide interim leadership when an organization suffers the tragic loss of a visionary founder. Truly innovative affiliation models go beyond assisting during temporary crises and create long-term stability by implementing strategic investments and recognizing that clear educational materials can attract sophisticated investors into vehicles like municipal bond offerings.

As any cursory survey of news headlines reveals—new federal investigations into Medicare fraud accusations, reduction of funding for homeless services, organizations announcing closures citing inflationary pressures—the landscape in the human services sector isn’t going to turn suddenly rosy. And the future for a family like the one in Colorado isn’t suddenly going to be white-collar jobs and stable housing. But it would help if they knew their disabled daughter had the daily support of a secure, safe, personalized program staffed by professionals who loved her as much as her parents and transportation to get there. It would help if they knew their son was offered counseling support services in an environment where he felt comfortable. It would help if they had access to knowledgeable professionals capable of assisting them in navigating bureaucratic processes for applying for housing assistance.

If we are to sustain the missions of providers doing the unheralded, exhausting work of ensuring that whole populations don’t fall through the holes of our social fabric, we’ve got to think in new patterns. Developing durable, flexible nonprofit networks may become one of the most important solutions for protecting long-term consumer access in underserved communities.