I Am Boundless Brings Whole Care Continuum to I/DD Population, Making Moves to Value-Based Care

When it comes to behavioral health, Ohio has garnered much attention due to substance addiction plaguing wide swaths of the state. But outside of substance use disorders (SUDs), there are many Buckeye State residents needing behavioral health assistance for very different reasons, such as for autism and other conditions related to intellectual and developmental disabilities (I/DD).

Enter I Am Boundless, a Worthington-based nonprofit which since 1980 has been offering various behavioral, day and residential programs to special needs individuals in the country’s seventh-most populous state.

I Am Boundless originally got its start as Franklin County Residential Services (FCRES), a municipal agency that provided developmental disability services to residents of the greater Columbus area. FCRES would subsequently spin off from the Department of Developmental Disabilities for Franklin County to become its own agency in the 2000s.


In 2018, the organization — which was no longer under municipal control and had gone through several name changes — was rebranded as I Am Boundless, offering a variety of services such as counseling, psychiatry, autism care, employment assistance and residential support.

Patrick Maynard is I Am Boundless’s CEO and has been leading the company’s growth efforts since arriving at his post in 2017. Serving around 5,000 individuals in a majority of Ohio counties, I Am Boundless now employs a staff of nearly 300 and has more than tripled its budget since 2016.

The organization’s newest offering is a unique program called Boundless Health. According to the organization, Boundless Health is Ohio’s first center to offer a continuum of care to individuals with I/DD and other complex needs, which includes whole-person, integrated primary, dental, behavioral and mental health care.


Maynard says even more is on the way from I Am Boundless. He recently talked with Behavioral Health Business, where he discussed the evolution of the organization from its modest beginnings as a county agency, its growth as an independently-run I/DD provider, its plans to possibly expand outside of Ohio and more.

Portions of this interview have been edited for length and clarity.

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BHB: Talk about how I Am Boundless and how grown to become the provider it is today in Ohio.

Maynard: When I came to Boundless, it was called Franklin County Residential Services. It was originally an organization that had separated from the county board of developmental disabilities. In Ohio, we have county entities for substance abuse to mental health disorders, and then intellectual and developmental disabilities. Medicaid had determined that county boards could not provide services and oversee and pay for services. We were the first in the state of Ohio to privatize.

When I came to Boundless, it was a single lane of services that they were serving to adults with disabilities in Franklin County. It mostly was just residential services. At that time, we had about a $23 million annual operating budget that served about 800 people. Fast forward to today, we are closing in on $100 million dollars, we’re in almost every county in the state, and serving about 5,000 individuals.

We have expanded from that single line of services for adults with developmental disabilities. We’re in behavioral health, which is about half of what we do now. We’ve done that by basically combining and acquiring other organizations and expertise. When we asked our constituencies six years ago what they needed, they told us that when it comes to disabilities, it’s more than just adults and residential services. There’s kids with autism and severe behavioral issues, and there’s a need for things like employment services, day programs and more. What we’ve done over these past six years is to acquire that expertise and integrate it with everything we do.

Can you specifically talk about the various offerings of I Am Boundless?

We do distinct things. We have residential programs, and community residential programs, and we range from specialized nursing homes, intermediate care facilities, to support individuals living in the community as independently as possible, such as an apartment.

We have day programs where people with developmental disabilities might go during the day, where they’re learning skills, coping skills, housekeeping skills and life skills. We have employment vocational services, we have behavioral health services, and now we have health services. We’re trying to integrate all of those things.

If somebody presents to Boundless and says, “I want residential services,” we could do an assessment with them and say, “You need residential support, but you also have a substance use disorder, you have some sort of a health disorder, you need dental care.” We can offer all those things to support the person by integrating health services with social determinants of health, which is cost effective .

What are some key targets that I Am Boundless is looking to hit on right now as it rolls out Boundless Health?

Two things are really important right now. One is the integration of services. People could have a disability and a mental health issue, or have substance use disorder. Recognizing all those different things, and being able to provide different types of services, is key for anybody in our line of business at this point of time. Efficiency is very important in a value-based payment system that we’re rolling into now.

The second opportunity for us developing and integrating primary health services into this. When we discovered the platform of a federally-qualified health center — which takes Medicaid and then enhances payments — we recognized a couple things. One is that we could get a higher rate of pay for services we were already providing that under typical Medicaid would barely cover their costs, and sometimes didn’t cover their costs. All of a sudden now it’s going to cover their costs and more.

The other thing was just having a platform that actually would pay for and support this in a sustainable way. That was for primary health, dentistry, pharmacy, all the key things that this population is desperately in need of. We’re going to start off small, because it’s hard to start up a health clinic. It’s very expensive and time consuming. So we’re going to start this year with primary health services, and dentistry And then early next year we’re going to bring in pharmacy and some other specialty services.

You mentioned value-based care, which has become more en vogue among behavioral health providers. How does that fit in with I Am Boundless’s overall goals?

Behavioral health has been involved with value-based and outcomes based payment systems for quite a while. But the intellectual and developmental disabilities world, in particular, has not. In Ohio, it’s still carved out from Medicaid managed care, but we see the writing on the wall, so we have prepared ourselves and are negotiating for value-based payments for that population. We’ll be one of the first to do that.

I find it refreshing to be paid that way. To have a system that’s paid based on good outcomes, instead of numbers of people served, it’s a good use of resources. I like the values behind that. instead of how in typical health care, where you’re jumping from person to person because you have to have so many patients to get paid, we’re going to get paid for the quality of services that we’re providing. That’s built into our mission.

I Am Boundless had been around long before you assumed your post. Knowing its history, why do you think it was able to grow from being a small county organization to a significant nonprofit service provider throughout Ohio?

It’s entirely driven by demand for services. We provide such a great quality product of services that enhances and increases the demand, so they both go hand in hand. We don’t grow for growth’s sake, we go where we’re invited and where the demand is there. Because we’ve grown in size and capacity and scope, we have resources that enable us to do that randomly.

Providers across behavioral health have been making more use of remote care during the pandemic. Does telehealth currently factor into I Am Boundless’s services?

When a county or an agency or somebody says, “Can you come in and provide these services in Allen County,” you know, we’re able to do that because we have resources and capacity to do that. Of course during COVID, some of our face-to-face services shutdown temporarily. But we already had a strong platform for virtual services, and we were able to expand that platform.

When COVID really struck Ohio, we were in over 20 counties. By September of that same year, in the midst of COVID, we were in some many more counties, and a lot of that is that we could expand our presence through virtual services that were available, and we had the capacity to do that. That was an opportunity I think we took advantage of, and as time goes forward, I think our service field is going to be a hybrid. Some will revert back to face-to-face therapies, but others, that they’re comfortable with virtual therapies and services. We’ll continue to offer both.

Concerns have been raised about whether telehealth can effectively serve individuals with autism and other behavioral conditions, some of whom may not respond well to audio and visual stimuli. How has I Am Boundless’s clientele responded to telehealth services?

Historically, we felt this type of clientele needs face-to-face services. If somebody would have said, “Let’s offer them virtual or teleservices,” we would have said, “No.”

COVID demanded that we had to provide those sorts of services. It was a lifeline

for a lot of people who had nothing else and were sitting at home, which wasn’t good for them, and it wasn’t good for their family. This provided a lifeline, so at least we were there and engaged with them.

Going forward, it’s a case by case thing, but I think it’s expanded our acceptance that for some people in some types of services, it’s fine. It’s maybe even more than fine. Maybe it’s a good service for some people who may live in rural communities, have transportation issues, or agoraphobia and can’t get out or don’t want to get out, and would just cancel meetings. Being able to engage with people is better than nothing, and in some cases, that might even be a better form of therapy. But if we can get people face-to-face, we will.

Boundless is now in over 50 Ohio counties. Has it considered the possibility of expanding services to surrounding states?

We’re not growing for growth’s sake. We’re growing with demand and an invitation. We’ve met with some state directors of some of those neighboring states, and they have said, “We would love to have you come.” Pennsylvania is right next to us. We’ve been invited by their director of the department of disabilities and behavioral health services, and we’re exploring how best to do that. I would expect in the next year or two, you can probably see us expanding into other states.

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