The Nonprofit Leader's Guide: Transcript of How Boundless And Merakey Plan To Scale Without Losing Local Heart

SCOTT LIGHT 

Welcome everyone to the Nonprofit Leaders Guide brought to you by Boundless, the podcast where we explore the ideas, innovations, and leadership strategies shaping the future of human services. Now, today we are discussing a huge development in our field, the recently announced affiliation between Boundless and Merakey. While many affiliations in healthcare and human services are driven by financial distress or organizational necessity, leaders from both of these organizations have been clear this is something different. They describe it as the creation of a whole new operating model, one designed to combine the scale, infrastructure, technology, policy, and resources of a national organization with the local expertise and relationships, culture, and regional leadership that have always been at the heart of mission-driven services delivery.This is actually episode two of this series. And I'm joined now by Jennifer Rija, Chief Strategy Officer at Boundless. She's been a frequent guest on the podcast these last several months. Jennifer, it's good to see you.

JENNIFER RIHA

Thank you, Scott. Great to be here.

SCOTT LIGHT

This is huge. I mean, we're just, we're all smiles right now, right? So for listeners who maybe just heard that conversation or maybe they heard this news, how would you describe this model if you had to just break it down super simple?

JENNIFER RIHA 

You know, one of the ways that I've thought about it that is simplest for me to think about it is the United States and the ways in which there are authorities and responsibilities that are held at the federal government level. And then there are authorities and responsibilities that are held at the state government level. And so different states make very different choices about how to allocate resources, what to invest in, what to focus on based on the unique culture, demographics, features of their state and their residents. But all states also receive the benefits of the national federal government in terms of things like national debt policy, national security, national research funding, and so on. And I think that might be a really simple way for us to think about this approach.

SCOTT LIGHT 

Wow. And just so our listeners know, we don't rehearse these answers before this. And Jennifer, I just got to say, as we're celebrating America's 250th birthday, I, you know, as your comms guy here, I kind of got chills. Seriously, I think that's a really great way to button it up.

JENNIFER RIHA 

Thank you. I've thought about it a lot. And to me, that just sort of is the cleanest or clearest symbol of what it is we're trying to build and the level of impact that we're hoping to have on both the sector and quite frankly, history.

SCOTT LIGHT 

Okay. Let's dive into it. The sector, history, we've got a lot to cover here. What makes this affiliation different from, say, the, you know, the traditional merger, the traditional acquisition that we've talked about on recent episodes here?

JENNIFER RIHA 

The very clearly stated goal that you've heard both CEOs talk about of preserving and in fact amplifying what makes boundless and future regional affiliates special and unique, balanced with the benefits of shared national resources. That is what is fundamentally different. Many MAs across all sectors, not just health and human services, are entered into with a very specific goal of streamlining or cutting costs to maximize profits. That is specifically not the goal here. The goal here is truly to develop a new relationship approach that creates a future where strong, locally led nonprofits are able to share resources, benefit from shared infrastructure in such a way that they're much stronger long into the future than any one of us could have been on our own. So I think the very fact that the goal, the purpose for doing it is what makes it so different.

SCOTT LIGHT 

We won't roll out the whole org chart here, but I've got a question when I'm thinking about again what you said off the top about the comparison to the United States. So what elements in all this, again, we're we're talking broad here, but what elements in all this remain local? And then what are the elements that become shared regionally and nationally?

JENNIFER RIHA 

That is an excellent question. And I don't know.

SCOTT LIGHT 

I love it when a leader says that. Seriously. I love it when a leader says that. You know, we don't have that answer just yet.

JENNIFER RIHA 

Yeah. So I only say that somewhat jokingly, because part of both the beauty, and I'm gonna admit it right now, the challenge, what we are building together is that neither of us have figured this out yet. And I don't think there's really anyone who can fully answer what elements remain local, what elements are best shared. What I can tell you is that both of us are completely committed to programs, services are being locally led. And locally, I think this is important, locally decided on based on what do the local communities need. That people who are in those communities understand the culture, understand what's going on on the ground, and that's who needs to be making decisions about programs, services, who needs to be having the relationships with local leaders, local politicians. Something is lost when that's not local. We've theorized that some of the potential ways that we can share infrastructure are shared technology platforms, shared employee benefits, shared purchasing power. But honestly, all of that is theoretical and quite frankly, exactly what we're going to be figuring out together over the upcoming months and years.

SCOTT LIGHT 

I would also encourage folks, if you haven't listened to episode one and didn't listen to, haven't listened to that conversation between between Joe and Patrick yet, do that because Jennifer, to your point, these are two leaders who share the stage, if you will, and you can tell they have a relationship. And it was a conversation that's 30 or 40 minutes deep. This wasn't uh, you know, you've seen conversations from other CEOs on a cable TV or a CNBC or something like that. And you can tell in the first three minutes if it's stilted and they're, you know, they just don't know who's gonna say what. And this conversation is exactly the opposite between Joe and Patrick. And I and I think it to your point, it just gets to how well thought out this is heading into getting into those challenges. Does that make sense?

JENNIFER RIHA 

It does. I think that the shared commitments and the shared goal allows us to give a lot of grace in making the decisions. And really, one of the things we we've talked about, sort of looking back on how all of this has gone, is that it's a little bit remarkable how few bumps in the road there were. And I think that that's a testament to both parties because of the relationship, because of the trust that was built, assuming good intentions.

SCOTT LIGHT 

And we've been real honest on these episodes, too, you know, we talk, we address problems, we talk about challenges, workforce pressures, reimbursement challenges, increasing regulation, rising expectations for those good, those great outcomes that we want. We're real honest about that, about what the industry is facing. Looking forward, why is scale becoming increasingly important in our field?

JENNIFER RIHA

You know, I think about healthcare and human services broadly, and I think you can see it really clearly in healthcare. We have built a system that rewards volume. If people really understand how the healthcare system in the United States works, generally a healthcare provider provides a medical intervention or a certain number of minutes of a medical intervention or a healthcare service, and then they're reimbursed based on that thing. You do one thing, you get one dollar, and so on and so forth. The challenge as we sort of look ahead is especially when you consider the changing demographics of the United States and the aging of America's population and the increasing need for health care and human services that there is going to be as we look forward, combined with the shrinking of the American workforce over these next couple of decades, what we have built is not sustainable. And I would even argue, even if it were sustainable, what we have built is not what we want. We don't want to be rewarding volume. We want to be rewarding quality, we want to be rewarding outcomes. All of us want, whether it's our doctor or our caregiver for our loved one, we want the reward to be based on quality and outcomes. But in order to actually reimburse that way, we need to truly create a different kind of provider infrastructure. And we've incentivized and built an entire system around a different set of rewards. And in order to make that transition, you need scale to be able to invest in the kinds of changes that are needed, whether that's technology, whether that's staff retention, whether that's just looking at being able to attract the best and the brightest minds. We need a different kind of health and human services system for the future. And that requires investment, which requires scale.

SCOTT LIGHT

A couple of months ago, I went in for my annual visit with my our family doc. And he comes in. I've been with him for 11 years. And he comes in and he's like, Scott, I see 20 to 25 patients a day. And that's the system I'm in. And he said, I'm tired. And I said, Doc, I've got you by 20 years. You first of all should not be telling me you're tired. But he said, you know what? He said, Um I'm getting out of this rat race and I'm gonna go to that concierge. You know, they call it the concierge model. And I said, How do you make those numbers work? You know, financially. He's got kids, he's got a family, everybody's got a budget. And he said, you know what? He goes, I can see half the patients. I can provide considerably better service, and I'll get to know my patients more, and the numbers work. There's a movement out there brewing, uh, I think to your point about fee for service and volume.

JENNIFER RIHA 

Yeah. And you know, in Ohio specifically, uh most people don't know this, but we have somewhere between 500 and 700, I'll call them broadly behavioral health. And by that I mean mental health providers, substance use disorder treatment providers, um, intellectual and developmental disability services providers, agencies in Ohio. So think about the infrastructure that it takes to support 500 to 700 agencies. Now, what if those were at least some of them sharing resources? What better systems would they be able to afford? How much more time could they potentially put into programs, services, time with patients, to your point, if we didn't have to spend that kind of money on overhead and infrastructure for all 500 of those or for all 700 of those? And so we truly believe that in collaboration, in partnership, we can deliver better service and we can truly shift the conversation to quality and outcomes versus volume.

SCOTT LIGHT 

You you teed up exactly what I wanted to mention next, because you talked about um sharing infrastructure, building out bigger and better technological systems, data, expertise, everything. So if if once we do all that, then the outcomes, the quality outcomes that we want, it's it's bound to improve.

JENNIFER RIHA 

You know, I think about a funny story from my own life earlier over the winter. So I have a very long-haired dog, and he occasionally is a complete mess and needs brushed and all of those things. I probably don't do it frequently enough. And he had little like matted knots. And so I needed to use scissors to cut those out. And I could not, for the life of me, find scissors anywhere in this house. I have no idea where they went. My children, I don't know, eat scissors for some reason. But I did what every logical person does. I went to Amazon. I ordered a three-pack of scissors to arrive in two and a half hours. And then I had my three-pack of scissors and could go on with combing my dog. But the point is that's the world we live in now. Absolutely. Absolutely. Where when we have a problem, we expect to be able to solve it efficiently with quick accessibility. And then people enter our system. And it could not be further from that experience. The system that we have built, it doesn't work that way. And the technology, the systems to get into services, and I'm going to be honest, even at Boundless, it is not great. It is hard. I think I've shared in the past, I'm the mother of a son with a developmental disability, and I struggle with navigating the system. And Ohio has a great system. So I bring that up to say if we do this right, being able to access these services, these services being integrated, being able to offer a broader array, a more personalized service, that is what people should expect as the outcome of this. Like you said, the quality, the outcomes, it should be a natural outflowing of us doing this right.

SCOTT LIGHT 

And Joe and Patrick were talking, and we've talked other episodes that we've had right here. We've talked about the difference for nonprofit providers. We've talked about the differences between surviving and thriving. And I and I think that's what we're getting to here and what we've been talking about the last couple of minutes. This is what thriving will hopefully look like.

JENNIFER RIHA 

That's right. That's right. And I do think that that's important because there have been a lot of organizations that have uh come together through mergers and acquisitions because there was a crisis, or because they're uh one of the organizations needed rescued. And the fact that Boundless and Merakey have had the foresight to say, no, we want to have this conversation when we have choices. We want to have this conversation when we can design what we want the outcome to be, I think has put us in a very different place to truly build something that we believe is going to result in thriving organizations versus organizations that just barely made it through because they needed a rescue.

SCOTT LIGHT 

We've also talked about, and again, uh I credit you and other leaders we've had here for being brutally honest about profit margins. This is not an industry that that gets double-digit, you know, Apple, Amazon, you know, AI company type profit margins. It's in the it can oftentimes be in the low single digits. And if that, right? So when we do combine and go to scale, what types of investments then become a reality?

JENNIFER RIHA 

Well, I think technology is an obvious answer. So I mentioned those, you know, five to seven hundred organizations just in Ohio. And truthfully, that is the same all across the country. So we're talking about thousands of organizations who are investing in implementing the technology system they can afford. And I can guarantee that is not the best technology system that is out there. So often what we end up with is every one of these organizations has a probably substandard technology platform that they are trying to run HR on, that they're trying to do recruitment with, they're running financials, they're doing all of their billing, they're doing their electronic health records. What would it look like if that investment were consolidated and we could buy the best product on the market? How much more efficient could we be? How much more money could we then reroute into programs and into services, into coming up with solving societal problems? I also think about training and professional development. And this isn't just our industry, but is definitely a thing in our industry that oftentimes people who are great direct support professionals or great therapists or great case managers end up getting promoted to being managers or might even end up getting promoted to be directors. And as a whole, we don't do a great job in teaching them how to be great leaders, both the management skills, but also the leadership skills. And so I think about that as a huge opportunity to develop people into truly creating exceptional leaders for these organizations. That again, the natural outflow has to be better quality, better outcomes because you are developing, retaining, creating these exceptional leaders within these programs, within these organizations. And then as I mentioned before, just the ability to attract the best and the brightest minds and talent. I mean, think about what it would mean if we were able to compete with the Google and the Amazons and the Apples. Now, I'm not saying we're we're gonna be there tomorrow, but what if that's the level of executive leadership talent and management talent that we were able to attract? How much better could our businesses be run? Again, not because we're trying to get big profit margins. These are nonprofits. We don't take the money home. None of us own this. When there's margins, we get to reinvest it in programs and services and people and communities. And so for me, that is what is so exciting about being here on the ground floor of beginning to build it.

SCOTT LIGHT 

Retainment is huge. I I've, you know, I've watched and and conducted interviews with with CEOs for a long time, and they they will always say the best thing we can do is retain our people because if you're spending, you know, gobs and gobs of money retraining new people who are coming in, and if there's just a constant in and out flow, you're you're not getting anywhere.

JENNIFER RIHA 

Well, and it's so critical in our space. I mean, think about this the vast majority of the people that we employ and that Marake employs are people who are frontline services providers. So these are people who are in some cases in someone's home five days a week and they might be the first shift worker, and then there's someone else who's there, you know, for second shift or third shift, or maybe they're at your um child's center providing services all day long with uh these students. When that role turns over, that is so hard for the people that are being served, for the families. And it makes a huge difference in outcomes when those roles are stable. And I will say those are the hardest roles to keep stable. So if we can have the impact of improving stability in those roles, that right there is a direct and obvious huge boost in quality and outcomes.

SCOTT LIGHT 

That's an easy tee up to. I was thinking about for folks who are listening to this and they receive services. We all know that it's, you know, it's kind of in our our human DNA to resist change sometimes. And change scares people. And it can be scary sometimes, but it it can also be very exciting, as we've been talking about. So for people who receive our services, what's your message to them?

JENNIFER RIHA 

If we do this right, the outcome should be uh that uh the people who are delivering care to you or your loved one are the same people, but now they have better tools, better resources, better infrastructure to deliver that care and to provide those services. And there is less burnout. They have the ability to stay in the roles much longer. They themselves have more career opportunities, but then there's that time for them to train other people. And ultimately, if we do this right, if we do this well, the people that we serve should be the biggest beneficiaries of this. Additionally, you know, we talked about all of the problems, all of the challenges, the barriers that are facing our sector right now. Um, Stacy's talked about it. You heard Patrick and Joe talk about it. The truth is the future is a little bit scary right now. When we think about what will services look like in five years, in 10 years, what's going to be available in 20 years? The answer to that question could be um pretty frightening. And this decision is in many ways a direct response to saying that is not the future we are willing to have created. So we are going to work to create a future where there is a thriving, stable, nonprofit sector in 10 years, in 20 years, in 30 years that is solely focused on making sure great services are still available in those communities. I think this gets to the whole survive surviving versus thriving conversation.

JENNIFER RIHA 

So I think at some point in the past, we've talked about Boundless's multisystem youth services. Now, the story of those, and I won't go into the full history, is that this was a huge, huge problem in Ohio. There were lawsuits, there were children being sent out of state. It was a terrible situation. And Boundless raised their hand back, uh, it was about 10 years ago now, to say we are willing to try something different, something hasn't been, something that hasn't been done in Ohio before, and essentially created the multi-system youth model in Ohio for children who had intellectual and developmental disabilities along with mental health needs. And that's been a huge investment over the years that we've continued to invest in and develop. And now that model has actually been replicated across the state and in some cases in other states. But Boundless had the resources to try something that hadn't been done before. And to me, that's the difference between just surviving and all of your, you know, whatever it is, 1%, 2% margin getting eaten up every year and just cost of living and increased cost of technology and increased cost of gas next year, versus having the money to focus on solving society's problems and actually investing and truly being innovative and creating what's next for the communities that we're serving.

SCOTT LIGHT 

Speaking of what's next, Joe suggested that this model could eventually include additional organizations. Um, who would be good candidates here?

JENNIFER RIHA 

You know, I think that the perfect candidates, if we can find the perfect candidates, are leaders. Leaders, both at the organizational level, but also even at the board level, who have looked at the world around us and see what is happening right now, understand what's ahead of us, and feel compelled, like we both did, to build something better and build something durable. Because I am going to be really honest, I don't have any illusions this is gonna be easy. I already said we don't have all the answers. But we think this is the hard work that needs to be done. So I think that the number one thing that we need in other potential partners, whether that's partners that are wanting to join Boundless as part of Boundless's region or become their own regional affiliate in a part of the country, is people who understand the why. If you understand the why, to me, it makes doing the hard work worth it. And it's what keeps moving you forward, even when it's challenging. And so the why that we've talked a lot about the natural outcome of this being better quality. So it's people who are committed to building that world and who really are focused on that as the North Star. And I think when we find those kinds of leaders, those kinds of organizations, that's who we need involved in this as our partners.

SCOTT LIGHT 

Well, and I can let our listeners know, because again, Jennifer and I are looking right at each other here, at least, at least virtually. And your your your honesty, your candor certainly comes across. But folks, I can let you know, Jenna's also smiling as she's talking about this. Like you're genuinely excited about this, aren't you?

JENNIFER RIHA 

Scott, I don't think I could be more excited.

SCOTT LIGHT 

And it comes across.

JENNIFER RIHA 

It's great. Yes, I am, I am so passionate about what this could be, what we can build, and truly the impact that we can have on changing the course of history, what we can make sure is truly there decades to come. I am just over the moon about getting to be getting to be able to be part of it.

SCOTT LIGHT 

That's a good place to wrap it up, to put a bow on it. Um, Jennifer, it's been a great conversation. Thank you again for being part of. We're calling again this one episode two of our series here. But again, just some big, big announcements and some big, big goals. It's just gonna be a great ride. And we'll continue to talk about it here. So again, Jen, thanks.

JENNIFER RIHA 

Thank you, Scott.

SCOTT LIGHT 

The healthcare and human services sector is entering a period of significant change, as we've been talking about on many episodes really over the last 12 months plus, as organizations face growing demands and tighter resources and increasing expectations. Leaders are being challenged, as Jennifer said, to think differently about a lot of things. Scale, collaboration, long-term sustainability. The affiliation between Boundless and Merakey offers one possible blueprint for how organizations can preserve local impact while gaining the capabilities needed to succeed nationally in a rapidly evolving environment. We thank you as always for listening to the Nonprofit Leaders Guide brought to you by Boundless. And if you enjoyed this episode or all of our episodes, any of our episodes, please subscribe and share it with fellow nonprofit and human services leaders out there. Until the next time, I'm Scott Light.