Rebecca Haag, MBA Change Management Consultant Former Chief Executive Officer, AIDS Action Committee of Massachusetts Michael Gifford, MBA President & Chief Executive Officer, AIDS Resource Center Wisconsin (ARCW)

Rebecca Haag, MBA Change Management Consultant Former Chief Executive Officer, AIDS Action Committee of Massachusetts

 Eliminate new infections: “Getting to Zero”  Maximize healthier outcomes for those infected, affected and at risk for HIV  Tackle the root causes of HIV/AIDS

 Serve 1 in 6 people in MA who are living with a diagnosis of HIV/AIDS  Client average annual income of is less than $10,000  194 Employees (76 are PT at Boomerangs)  Multiple Locations  Recent mergers with Cambridge Cares About AIDS, Strongest Link (North Shore) and Fenway Health

 FY’13 Results: Net Loss $187,482 (Audited)  FY’14 Results: Net Profit $293,159  FY’15 Budget: Profitable, sustainable services  Private fundraising on target  Contract Status: stable: 50% public

Care for Dying Care for the Living Connected to Care Improve Health Outcomes Crisis/ReactiveResetProactivePrepare for Future GrassrootsBuild SustainabilityExpand VerticalBroaden Horizontal Client ComfortClient SupportClient Stabilization Client Independence $ High$ Decrease$ StabilizedNew $ Sources Strategic Plan

 Environmental/Landscape Scan (SWOT)  Mission, Mission, Mission  Strategic goals and options  Criteria for partnerships/merger  List of potential partners: pros/cons  Timelines established  Barriers/Enablers

 Introductory conversation: Fall ’12  60 day go/no go review: Jan/Feb ’13  Due diligence: March/April ‘13  Decision to merger by Boards: April ‘13  Announced: early June ‘13  Official on October’ 13  New AAC Leadership in place: April ‘14

 Programs and Services Consolidated services for gay men: expanded testing hours, connection to care, more outreach STD “Clinic in a Box” access at AAC sites Health Library/Fenway Institute: collaboration & access  Organizational In first full fiscal year: saved $500k in back end work: : IT, facilities, finance, communications, purchasing  Outreach PrEP Awareness Campaign: clinicians & peer support

 Medical Home Model: leveraging AAC’s community based support services  Identifying new sources of revenue 3rd party billing for community services Build pricing model for integrated services model  New relationships and partnerships to grow and/or fill gaps  Continued integration of brand and organization  Train young leadership for the future

 Be true to your mission  Embrace change  Manage organizational/person ego  Be open to adjustments as opportunities arise  Be ready to fail; you will learn from these  Align head and heart before final decision  Move forward with speed and determination

Mike Gifford, MBA President and Chief Executive Officer AIDS Resource Center Wisconsin

 HIV Medical Home model of care  178 staff  12 clinics and offices  $56 million annual budget  3,500 patients and clients  40,000 people at risk with HIV

 1993 Northwest Wisconsin AIDS Project - Eau Claire  1993 Wisconsin AIDS Research Consortium  1997 Center Project - Green Bay  1997 Central Wisconsin AIDS Project - Wausau  1998 Northern AIDS Network - Superior  1998 East Central HIV/AIDS Organization - Oshkosh  1998 AIDS Service Organization – La Crosse  2015 AIDS Network - Madison  Surviving Agency: AIDS Resource Center of Wisconsin

 Identify the strategic intent of the merger  Focus on patients & clients and their outcomes  Invest significant amount of time in communication and relationship development  Focus on what will be gained  Set aside the history for a better future

 Legal Services – direct representation & brief legal counseling  Housing Services – residential housing, rent assistance, counseling  Case Management – medical and social work case management  Food Pantries – pick up and home delivery

 Lack of culturally competent care, quality care  Secured Part C grant; ARCW Medical Clinic opened StructureDirect provider Employ all staff Direct provider MCW, MD contract Employ non-MD staff Staffing1 Physician 1 Medical Assistant 6 Physicians 3 Nurse Practitioners 5 Registered Nurses 2 Medical Assistants LocationsKenoshaGreen Bay, Kenosha, Milwaukee Space2 medical exam rooms15 medical exam rooms Patients71,427

 Limited access to mental health for patients  Joint grant with FQHC StructureSubcontract recipient Employ all staff Grant recipient Employ all staff Staffing2 Therapists2 Psychiatrists 1 Psychologist 7 Therapists 3 AODA Counselors LocationsMilwaukee7 locations Patients14646

 Lack of integrated care; unrealized revenue  Opening of ARCW Pharmacy StructureSubsidiary for-profit LLC Staffing2 Pharmacists 1 Pharmacy Tech 5 Pharmacists 7 Pharmacy Techs 3 Pharmacy Interns LocationsMilwaukee Patients4172,468

 Doyne Hospital and its dental clinic closed  ARCW Dental Clinic opened StructureContract w/FQHCDirect Provider Staffing1 Dentist 1 Assistant 5 Dentists 4 Dental Hygienists 4 Assistants Space2 dental exam rooms10 dental exam rooms LocationsMilwaukeeGreen Bay, Milwaukee, Madison Patients671,407

 Significant increase in HIV/AIDS services  Significant increase in the number of patients and clients served  Enhanced long term financial strength  Increased public & private revenue  More cost-effective operations  Enhanced employee recruitment and retention due to improved salary, benefits, retirement

1992 ARCW Budget2015 ARCW Budget Federal Government$0$2,553,318 State Government1,663,9016,322,676 Local Government223,381767,427 Development521,9492,645,000 Pharmacy036,875,350 Reimbursement01,174,343 United Way0350,168 Total Revenue$2,409,231$51,044,295

Patients ARCW 2009 ARCW 2014 With an Undetectable Viral Load 69%85% Prescribed HAART74%95% With diabetes that is well managed NA83% Prescribed preventative PCP treatment 91%95% With controlled hypertension NA59% With controlled LDLNA77%

ResourceAuthorDescription AIDS Action Committee & Fenway Health: A New Vision for HIV/AIDS Services and Advocacy AIDS Action Committee & Fenway Health: A New Vision for HIV/AIDS Services and Advocacy (Case Study) Peter Kramer, Nonprofit Finance Fund -Overview of AAC and Fenway merger -Includes discussion of the rationale, catalyst, and challenges of the merger Strategic Restructuring for Nonprofit OrganizationsStrategic Restructuring for Nonprofit Organizations (Book) Amelia Kohm and David La Piana - Benefits/Costs/Challenges of Strategic Restructuring Partnerships - Future impact of Strategic Restructuring on the Nonprofit Sector

ResourceAuthorDescription Sector Transformation and Organizational Sustainability Sector Transformation and Organizational Sustainability (Webinar) National Center for Innovation in HIV Care (Vignetta Charles) -Overview of sector transformation in the world of ASOs -Cursory discussion of models of merging, growing, and closing (Merge, Go, or Grow) -Information on resources and grants for sector transformation Asking the Tough Questions: Self- Assessment toward Growth vs. Responsible Closure Asking the Tough Questions: Self- Assessment toward Growth vs. Responsible Closure (Webinar) National Center for Innovation in HIV Care (Vignetta Charles, Robert Cordero, John Gatto, Monique Tula) -Overview of sector transformation -Three organizational leaders perspectives on their process of deciding to strategically restructure Getting your Board on Board (Webinar) National Center for Innovation in HIV Care (Brian T. Carney & Kandee Ferree) -Overview of board governance and the role of a board in organizational restructuring -Includes tips for working with boards around restructuring

 Webinars are available on our website for on-demand viewing.  You will find slides from today’s presentation posted to the front page of our website:  Please complete the evaluation at the end of the webinar. Your feedback will inform our programming.  If you are interested in individualized technical assistance, please visit our website and complete a TA Request Form.  Join us for our other webinars this month! Optimizing Linkage, Engagement, and Retention in HIV Care for Adolescents and Young Adults of Color Tuesday, April 14 at 2:00 PM ET (Registration available at our website: Conclusion Slide