Seven years ago, I Am Boundless generated about $25 million and served about 800 people a year. The organization now serves more than 6,000 people and brings in about $170 million.
How?
The growth strategy was two-fold: on the one hand, the Worthington, Ohio-based nonprofit organically added and expanded services. On the other hand, it acquired or merged with similar organizations. This led to I Am Boundless becoming the largest private provider of disability services in the state.
It has also made the organization one of the most diversified health care and social services organizations out there. It seeks to provide integrated care services that address a near-total range of needs for people with and families of those with severe behavioral health conditions and intellectual/developmental disabilities.
It offers primary care, dentistry, psychiatry, speech and occupational therapy and applied behavior analysis (ABA). On top of that, I Am Boundless provides several types of residential, community and integration services for those with IDDs.
By acquiring similar organizations, I Am Boundless aims to eliminate some redundancy in the nonprofit health care and social services sectors, maximizing limited resources.
“When we look for organizations not like us, we look to bring everything [I Am Boundless] offers into that organization and everything that organization offers in I Am Boundless,” Jennifer Riha, chief strategy officer for I Am Boundless, told Autism Business News.
For example, I Am Boundless announced that it would merge with Independence, Ohio-based Koinonia, in September 2023. Today, the combined organization employs 3,000 people and operates in seven locations. This merger added to I Am Boundless’ residential and day service offerings.
Riha’s duties are extensive and resemble many of those of her peers in the for-profit behavioral health industry. She oversees strategy, innovation, advocacy, partnerships and M&A initiatives within I Am Boundless. In her time at the organization, she has held several roles. Most recently, that included vice president of programs. She was named chief strategy officer in January.
She will be participating in a panel discussion entitled “Delivering Whole-Person Autism Care Strategies” at Behavioral Health Business’ inaugural Autism & Addiction Treatment Forum in Chicago on July 18.
The following Q&A based on ABN’s interview with Riha has been edited for clarity, length and style.
ABN: What are some of I Am Boundless’ goals for 2024?
Riha: 2024 is a very interesting year for us. We made the decision this year to make a big investment in technology platforms for efficiency and scalable processes and systems.
We’re spending a lot of time this year implementing things like a new electronic health record, a new financial platform, a new philanthropy management platform, a new contracting platform, and a new telephony platform. This is across the whole organization, with a real focus on making a big investment on things that are going to put us in a good position for efficiency and scalability in the future.
One challenge highly diversified health care and social services organizations have is having an EHR system that meets the very many and often disparate needs of those organizations. Has I Am Boundless been able to find one EHR that will help you meet your goals?
Over the years, we’ve jokingly said that it feels like we’re collecting [EHRs] like trophies. We had gotten up to seven EHRs. We’re not going to be able to move to one system. My personal opinion is that the single system that does what Boundless does well doesn’t exist. The approach that we’ve taken is to look for systems that consolidate where we can but are also best-in-class and give the practitioners and the clinicians the opportunity to do what they do well and efficiently and reduce friction for them.
We’ve built out a pretty robust data warehouse and architecture that pulls in data from all of the different systems and puts them into an analytics platform that allows us to look at the whole person or do analysis by bringing in different systems and different feeds.
It sounds like you have been thinking about the data part of your operation for a while. What has been the most important part of having and collecting that data? Where do you think it will take you in the future?
We have been able to be very clear and concrete about what it costs to deliver care versus what rates we are contracted for. It definitely helps us from a payer conversation.
The other interesting thing that I get very excited about is being able to pull in information, for example, from IDD systems, from our state’s health information exchange, from our own primary care data and look at the impact of care on people. We realized that young adults who were enrolled in our transition-aged youth program and were really engaged in getting these services saw a reduction in hospitalizations and emergency department utilization for the same youth during the same time period prior to participation and enrollment in the program. That was not one of the stated goals of the programs. But by having this robust data set, we were able to see this correlation, and that gives us insights into asking questions about what is it about this program and this engagement that’s resulting in these other health outcomes.
Looking to the future, I personally am very excited about the potential of large language models and AI to potentially give us insights into questions I haven’t even thought to ask and show me correlations show us suggestions based on these large data sets around how we can best deliver care and really what is making the difference
What have conversations with payers been like about the model that I Am Boundless presents to the market?
The reactions that we’ve had from payers of all sorts, including the Medicaid managed care plans, have been really positive. I think we are probably a bit different than your typical nonprofit provider. There’s been a lot of interest and excitement around being able to participate in alternative payment models, as well as even exploring some opportunities for shared savings.
We currently engage in various alternative payment models and outcomes-based payments with a number of payers. We’re exploring some things that I’m pretty excited about for 2025 around thinking holistically about the total cost of care for the whole person.
How are things looking in terms of workforce efforts?
We’re very fortunate to have a legislature that listened in 2023 and made some pretty historic investments in rates, specifically tied to addressing workforce challenges and wages. We are seeing the impact of those investments. I wouldn’t say we’re 100% staff, there’s always the need for recruiting and focusing on retention.
But as we step back and look at the bigger picture, we consider the role that demographic shifts are having in workforce challenges. All sectors are likely to experience increasing workforce shortages, just because of the labor force in the U.S.
There is an interesting dynamic with regard to human services: at the same time that the labor force is shrinking, the demand for our service — whether you’re looking at caring for people as they age, people with autism, people with mental health conditions or SUD conditions — is exponentially increasing while this resource is shrinking.
I believe and we believe that good pay, focusing on retention and a good culture are important. We as a sector have to be thinking about the future in terms of alternative thinking — whether we’re talking about technology’s role in service delivery, whether we’re talking about natural family and natural supports functioning in a different way than we have in the past.
What other big-picture issues are on your radar?
We’re actually in the very early stages of getting ready for our next strategic plan. I’ll share a few of the thoughts we’re focusing on. We already touched on the role of technology.
We’re also very focused on the need for cash reserves to create flexibility. We’ve seen a lot of change in the last 20 years. We think it’s really important to be able to be flexible and resilient as an organization. And the reality is to do that, in the long run, you really do need cash reserves.
We also think about scale. We do feel that both diversity and then literally just volume — when you’re thinking about alternative payment models, you’re thinking about population health — you need to have a large enough population to be able to manage risk.
One of the other things we’re thinking about a lot is what the role of organizations like ours will be in the future if we know that there will be potentially fewer people to do this work. Where can Boundless make the most difference? We do think that some of the solutions, whether it’s around natural families or technology, are going to have to be part of the solution for the less complex population. We’re also thinking about what models of care meet the needs of the most acute and the most complex cases.
