The Business of Caring, The Art of Caring

A CEO’s Perspective on Encounters with Daily Challenges

CEOs are humans. They are not deities, miracle workers, or “masters of the universe.” There are no special, secret schools where CEOs are turned out. While proud of hard-earned advanced degrees – masters and higher – they all learn the hard way through the well-known “school of hard knocks.”

What makes CEOs special? In a questionnaire to ten heads of human service agencies, the ability to navigate the rough waters of the government-funded and regulated-world is critical. I am reminded of President John F. Kennedy’s famous quote, “Controlling the bureaucracy is like nailing Jell-O to the wall.”

A sense of humor is certainly an asset of the stand-out leaders I know.

Effective CEOs convey optimism to their workforce and boards, while creating environments where employees are valued and invested in their work.

Serving as the executive of a human services agency is a daunting and humbling experience under any circumstances, notably today as complexity mounts from multiple pressures. Chief among these are even-tighter limitations on funding; workforce turnover; and demands for quality from many oversight bodies. Just “doing well” is not nearly enough.

Believe me, CEOs deserve tremendous respect for their efforts to attain success. Consider that among their heavy responsibilities is working and planning to constantly prepare for economic survival in a difficult fiscal world. I am certain that the insights provided by the executives in this article will give you, the reader, a new appreciation for our leaders of human-service agencies. I am grateful for their thoughtful responses.


The safety net in our communities is more essential than ever to ensure a quality of life and increase the opportunities to succeed for people who are living with disabilities; facing income inequality; and falling short of having even their basic needs met. The latter is unacceptable – even disgraceful.

I want to share with you the perspective of experienced CEOs who manage the very safety-net programs that make a difference every day for people who are economically, physically, and emotional disadvantaged and disenfranchised.

Without exception, the agencies that are the center of this story are highly – if not totally – dependent on public dollars. In the language of economists, these agencies are providing public goods by carrying out public services for individuals who have gained certain public entitlements and benefits through hard-fought legislative battles, legal victories, civil rights actions, and political activism.

The other common fact of life is that funding for the safety-net programs never really matches the cost of care or lines up with regulatory mandates. Nor does the funding totally fulfill the high level of expectations that society assumes will be delivered, or serves all the needs of the individuals who are often desperate for basic help to survive. Just as a matter of reference, the combined spending for these agencies is over $900 million from all sources.

As Bill Guarinello, President and CEO of HeartShare and Chair of NYIN, says:

In the face of diminishing funds, our leadership is forced to take stock of its core services and make difficult decisions about which programs make the cut each year.

Susan Constantino, President and CEO of the Cerebral Palsy Association of NYS and Community Metro Services, identifies . . .

the three big challenges facing our agencies are the recruitment of staff, particularly DSPs (direct care staff) and middle managers; reimbursement levels, which continue to drop (including the lack of trends), and preparation for managed care and value-based payments,

The leadership challenge every year is a balance between existential demands of the people CEOs serve with authentic, practical needs for financial viability of their organization. In essence, the CEOs must have a moral center and an emotional core that supports this balancing act so that tough decisions can be made and people get served

A prevailing and pervasive dynamic is the challenge of sustaining the respective human-service agencies over the long run. While every agency has some form of long-term planning or strategic thinking, it is an extremely pressurized atmosphere to think strategically, let alone bring to life any of those tactical decisions to sustain an agency. There is clear evidence that those agencies with active strategic plans are better positioned to face uncertainty and adjust to meet the changing forces.

Bill continues as he speaks to this point:

Each year, my board and I revisit our strategic plan, which is centered on succession planning and leadership engagement efforts. Similarly, we look to how we will grow and sustain our board by looking to cultivate young professionals who will become our next cohort of funders and advocates. We also work with board members to market our organization at their companies and within their networks.
Brand recognition and reputation are as important for financial contributions.

The boards, which are the cornerstone of governance for charitable organizations, are going through major changes because of the increased demand for compliance and risk management; for fundraising; and for a level of expertise and understanding of the sweeping public-policy reforms being rolled out at the federal, state, and local levels.

In response to public-policy reforms for Medicaid, upon which many agencies are dependent, one CEO said that…

looking at long-term trends, it is unclear how non-profit providers will
survive if we are being funded minimally, but are required to closely
model ourselves after the structure of private health corporations.

New York State is moving toward having all Medicaid recipients enrolled in managed care. The prospect of having mainstream, commercial companies controlling public funds is ominous for human-service agencies that have been accustomed to having government as the direct payer and protector.
All of the organizations in this paper are nonprofit agencies, which by definition are mission-driven. The stories that the CEOs tell go well beyond the words in a mission statement, right to the core values that get reinforced every day in all kinds of ways.

One executive states:

I’ve built and reinforced a culture of appreciation, including a family atmosphere at programs, a tradition of recognition, a policy of promotion from within, and support for professional development.

For this CEO and colleagues, the day-to-day reinforcement of values is the difference between building a lasting entity and one that barely survives. Balancing budgets; hiring and monitoring people; handling board meetings; sharpening the communications skills of writing and public speaking, and celebrating events are all part of being a CEO. While doing all this, the best CEOs serve as a role model, a lively and persuasive leader who motivates people and continually reinforces the agency’s
commitments and mission.

Tom Lydon, President & CEO, Lifespire and NYIN Member

Addressing the direct-care workforce crisis, I personally meet with every new orientation class. I thank them for desiring to work with our folks. I applaud them for wanting to make a lasting change in
the lives of our country’s most vulnerable citizens. I try to narrow the gap between direct-care workforce and CEO.

While being fiscally sound and viable have an overwhelming influence on the daily life of a CEO, this is seldom used as the cudgel to control and dominate as a leader. It is used to couch the tough decisions. Since nonprofits are not driven by the price of the shares (they don’t have any), they are freer to use smart tactics to be fiscally prudent. Their agencies are in for the long haul, not quarterly statements. Most agencies work with small margins, which by definition requires a level of financial and management
astuteness that does not come from any textbook.

New Approaches in Community Activism and Market Realism

Participating in provider-collaborative initiatives is a relatively new phenomenon for CEOs in human services, but one that is more and more common, if not imperative. Perhaps it’s obvious that providers coming together in common cause is an economic necessity to live in a marketplace where not only are there diminishing resources but new players controlling the allocations of those resources. Collaboration goes beyond this imperative and highlights the value of synergy through a common bond to do
better. Collaboration is about managing change in smarter and more deliberative ways.

Here are the words that define everyday executive conversations: synergy; shared learning; unity of purpose; achieving an end goal; broader accountability; viability; and creating a larger voice.

Getting to a comfort level to share is not easy because there is competition in the nonprofit sector. Each agency is vying for greater market presence while capturing more and more of the finite resources. Also, I have not found a CEO without a strong ego and big personality. It is an asset to be dynamic and a bit larger-than-life. The CEOs I know are proud of their accomplishments, as they should be.

One leader observes:

It’s rare for CEOs in the non-profit sector to collaborate often, which leaves many organizations in their own silos. Working with peers not only allows for the sharing of best practices, but also coming together to find solutions to the same problems we’re tackling daily.

Gaining economic and program strength through mergers and acquisitions is another part of the new marketplace demand for sustainability. Most of the agencies in this paper have been actively engaged in mergers and acquisitions. These activities often come about because of a particular agency failure.

Time is spent cleaning up failures, an undertaking that is fraught with unknowns and surprises. This characteristically takes more time and resources than anticipated. For the mergers and acquisitions that are part of the planned way of coming together, this is not easy, even with the greatest of alignment of financial and program resources and mission.

There is no doubt that the workforce demands in operating human service agencies are topmost on every CEOs must-do list. Without a dedicated and committed workforce, human service agencies could not survive, let alone fulfill their missions.

Take one agency with over 2000 workers of every type and skill set from front-line workers to clinical experts. With turnover of 20% or more each year, the challenge of recruiting and retaining a workforce drives quality and financial viability. Add the increasing demands of information technology, which require significant investments in recruitment of technology specialists, plus ongoing training.

Donna Colonna Says:

We engage staff at all levels in a discussion about what’s happening that impacts our work and organization so they can contribute and understand the external and internal forces at play and how we can adjust to thrive in the current environment. We lead with optimism about our ability to continue to meet the needs of those we serve despite reduced resources – requires us to work ‘differently.’

Amy Anderson-Winchell says:

We are in a discussion with our employees about what makes a good
organization great and are striving to be the person-centered organization
of our values and vision; committed to quality improvement
for the people we support.

In addition, the newest demands from government must be met, chiefly crafting new payment models that pay for outcomes (known now as value-based payments).

The challenge to build a workforce that delivers tender loving care while being efficient is tough for even the smartest CEO. It is truly an achievement to create a workforce where everyone is on board with the organization’s values and embraces its objectives. Needless to say, but often difficult to accomplish, is offering fair and competitive salaries and benefits.

As I listen and witness the CEOs in their world, I have become keenly aware of their dedication to the people being served by their agencies. The often warm and personal stories in our conversations, and in forums with co-workers, communicates a drive that goes beyond well-developed professionalism and reflects their humanity. I am convinced that leaders of human service agencies deserve to be put in the higher realm of doing good. Our society is in great need of these special persons.

The following CEO quote is an excellent example of what I call this specialness:

I ask by a show of hands if anyone has a family member with IDD. I expound about my life experience with my family member’s struggle to learn to communicate, complete ADL’s and excel despite his disability. I further narrow the gap when I tell them I, too, was a direct-care worker and know firsthand how hard the work can be at times. I believe a ‘good leader’ leads by example. I never ask anyone to do something I haven’t done myself.

Chief Executive Officers are engaged in a variety of forums for advocacy. Because they are delivering what are essentially public goods, the public policy governing funding, regulations, and compliance are a critical part of their lives and activities.

The collaboration discussed in this paper is a central focus of policy advocacy. While there are professional and provider trade associations that all the agencies participate in, the collaborative groups can often act more quickly, acting like a laser beam on an issue. Because of the size, professional status, and prestige of leading agencies, a specific communication to a public official gets immediate attention and response.

The New York Integrated Network for People with Intellectual and Developmental Disabilities (NYIN) is a good example of a collaboration focused on using the platform of provider agencies to develop innovative solutions for managed care, new service-delivery options, and clinical improvements in the new world of value-based payments.

NYIN is led by eight nonprofit providers who are particularly adept delivering a wide range of services to thousands of persons each year in the Metropolitan and Lower Hudson areas.

Managing Risk

There is a typology that I use to illustrate the challenges of leaders, which falls into two buckets. One is the business of caring versus the other, the art of caring.

While these are useful learning typologies, they are grounded in practical experience and observations. They also represent the growing and palpable tension leaders are feeling: Are we in the business of caring or are we driven by the art of caring? How could these models work in some compatible way? For instance, the business side demands measurable quality outcomes, while the art of caring is consumed with quality of life. How do these come together? Where, when and by whom?

The persons who receive vital services want assurance that their needs are being met by effective and proven methods of interventions and treatment modalities. At the same time, they are seeking quality and meaning in their lives.

For a person in recovery from an acute mental health episode, the pathway to gaining control is based on a belief that the support system will be in place. This also applies to children who are bouncing around he child-care system without any sense of permanency or stability. This is an enormous, humanitarian challenge that holds true across the wide spectrum of human services. The balancing act between the business of caring versus the art of caring is experienced every single day by CEOs.

There is much “to-do” about managing risk these days in policy and government circles. The discussion is most often centered on value-based payments. Numerous articles are published about risk management, but few dig into the nonprofit human services world to try to understand how these new models of payment are applicable. For the frontline, safety-net providers, the methods of payments have real consequences. Not everything human-service providers do is measurable.

The leaders of nonprofit and social organizations have been swimming in a pool of risks from the very origins of “social organizations” over 200 years ago. Safety by its nature is a term that policy wonks want to apply to low-margin entities that provide fundamental care to persons struggling to gain an ounce of independence and an element of dignity. Providers are often the voice of people who may get lost in their communities and are deeply impacted by internal and external circumstances.

Bill Guarinello

If I were able to address our policy-makers in New York and beyond, I would make it clear how essential human services are, despite the fact that they are rarely a budget priority. In New York, the rates for
people with developmental disabilities continue to be cut, and funds for after-school programs for at-risk kids are always on the chopping block.

Yes . . .

Yes, risk permeates the sinews of all nonprofit human service agencies. While the day-to-day is infused with making sure services are rendered, the smart agencies do everything possible to reinforce the heartening dignity of caring.

Yes, risk is an everyday phenomenon. It is now front and center of the overwhelming move by the public sector to demonstrate success and measure outcomes. This is not a bad thing, but is not fully developed or understood. Once again the leaders have to learn on the fly and gain mastery by doing.

And yes, government is willing to put at risk its constitutional responsibility and historical role to protect its citizens by imposing untested concepts of value-based payment methodologies.

Of course, everyone wants value for the public money that is spent. Indeed, consumerism has pushed virtually every field and industry to deliver on value. From banking to groceries, the demand for quality services or products at an affordable price is a driving force.

This force is just now reaching into the human service field. While we race “pell mell” to the altar of value-based models, we call into question the lack of solid building blocks for this new house. Risk management is the design concept, unfortunately with limited tools or logic about how to put VBP into practice.

The questions that beg for answers: What is being put at risk? The people being served? The dollars being spent? The services being offered?

Finding Solace, Comfort, and Renewal

From my experience of being in leadership positions for over 45 years, finding the personal space to renew or refresh your inner core is vital to being a CEO.

One of the most rewarding sections of the questionnaire was reading how each executive deals with pressures and challenges. I have depersonalized these quotes and mixed the sequencing so that each CEO would feel free to openly share. I think you will enjoy the replies and, assuredly, can fill in your own coping methods.

“My family is a great source of strength! I am a Deacon in the Catholic Church and I get to serve at a special-needs mass once each month. My ministry gives me the opportunity to see things that
divert my attention. Golf and other sports with my sons are a joy. And, my bride of 30 years is a constant reassurance that if I’d like to retire we’ll do just fine – a comforting thought. She is my rock! And
yes I tell her. I also enjoy playing guitar and writing. I’m currently taking bass lessons.”

“It is so important to find something that you love to do outside of your professional responsibilities. For me, that’s golf. I can spend 3-5 hours out on the course with no distractions. I also very much enjoy volunteering in my community beyond the human services field. Lastly, I rely on the enriching experience of keeping connected with friends.”

“Balancing work and family and your life is key.”

“My family, which now includes an amazing granddaughter, is the focal point of my personal life and wonderfully draws me in and away. My greatest breaks from the pressures of this work come from the opportunity to travel, which my husband and I do regularly, and often with family.”

“Spending quality time with certain friends over dinner is very relaxing. I also enjoy escapes from reality, which may take the form of going to movies/theater, driving alone with music outside of New York City.”

“I spend a great deal of time reading fiction and non-fiction related to 20th-century politics.”

“I bicycle with others as often as I can.”

“Today, considerably more time is spent with fellow CEOs as we come together and create new organizations. The work of a CEO feels, and is, different now. I’m trying to remember what my work life was like when I just had my ‘day job’ .”

“Prior to being CEO I exercised on a regular basis, even participating in a few marathons and half marathons. I pray throughout the day; I dedicate every Friday night as date night with my wife, my best friend. Most Tuesday mornings I attend a bible study at the NYSE. I enjoy the solitude of a long walk with my Irish Wolf Hound. I run a Sunday bowling league for people with developmental disabilities, using high-school volunteers – hoping to inspire them to become involved in the field.”

“ Opera is definitely something I do to unwind, as well as attending the ballet. I also spend time with my grandchildren who are a great source of enjoyment. Most importantly I run/jog as often as possible.”

In Their Own Words

The following, concluding section contains the questions and responses from ten CEOs. I have tried to edit these in a way to give you a real sense of how these executives view the world, and how they manage their leadership position.

What are the three big challenges facing your agency?

As expected, financial and workforce challenges dominate the concerns of executives. The issues around managed care are also now rising to the top of the list as community based organizations confront the flow of funds coming from managed-care entities.


We face several challenges in this climate. First, the City and State governments continue to cut the resources available to us. HeartShare is a government provider, which relies primarily on public dollars to operate its programs. HeartShare needs to uphold its fiscal responsibilities to its stakeholders, including the 34,000 children, adults and families in its care. Working with peers allows for the sharing of best practices.


We see our challenges as increasing our growth rate, retaining competent staff, and dealing with government ever-changing regulations and unpredictability.


Resource limitation is the biggest challenge and building a quality workforce is a major issue. The drive for innovation is also a dominant issue.


The single most significant challenge facing our organization, Access: Supports for Living, is recruitment and retention of the talented, value-based workforce that we need to fulfill our mission to help people live the healthiest and fullest lives possible.
A second challenge is the current rate and reimbursement structure and regulatory environment which do not provide the financial stability and flexibility to support the quality improvements needed to guide the service delivery of the future.


The three are: Having a secure financial base with cash, which is essential for both growth and sustainability; developing a more diversified portfolio of education, longterm supports and possibly health care; strengthening internal controls and capacities.


I think the three biggest challenges facing the agency are: the recruitment of staff, particularly DSPs and middle managers; reimbursement levels that continue to drop, which includes the lack of trends; and preparation for managed care and value-based payments.


The challenges are: Determining the most effective path toward agency growth; current reimbursement (rate) system in which there continues to be a lack of transparency and valid acuity measures; workforce changes have led to turnover rates more than double that of only 3-4 years ago.


The challenges are: Transition to managed care and value-based payment (and bearing risk!!); concurrent pressures on funding, particularly (but not exclusively) on Medicaid; need to get IT infrastructure up to the challenges of today; and workforce: managing a historically low-paid/under-paid workforce that now is exacerbated with an economy that has low unemployment and all that entails.

We have been bombarded with ‘stuff ’ (reforms) the past few years, and it has been humbling as successful CEOs to feel dumb and like we are in graduate school again, learning all this stuff on the fly while we try and manage our current operation and prepare for the uncertain future.


Direct-support workforce crisis; demoralized and under-appreciated, long-time staff; and government’s blind eye to what is going on.

What are some of the practical and concrete decisions you are making to meet these challenges?


Whether it’s expanding or integrating our services, we are making decisions aligned with our mission and values, leveraging the expertise of our peer organizations, and, most importantly, keeping our organization fiscally strong for the people who depend on us. Lastly, as CEO, I’ve spearheaded our involvement in NYIN, a collaboration which has now produced a collaborative response to managed care. I believe CEOs should make these connections a core part of their work—the innovative and strategic outcomes are
well worth the time and effort.


Capital projects are a priority. We have an older building that needs major repairs. Finding capital is very difficult. We have discussed the option of mergers as a way of surviving.


We are actively pursuing new programs including acquisitions; we are continually evaluating staff and aligning their strengths with duties and responsibilities. Being part of a collaboration helps to stay ahead of the curve in global changes.


A focus is on how to engage and build our board to support the need for unrestricted resources and partnering with businesses and communities. Continuing to nurture SUS culture is an everyday demand. Trying to create a buy-in around technology and data-including adaptive and communication technology continues to be a broad organizational goal.


We have added a LEAN (core principle is maximize customer value while minimizing waste) expert to our Senior Leadership team and are recreating how we work in many ways. A top priority is shortening the time to hire and the engagement of employees in our change process so that the results will increase their satisfaction and joy at work. We are similarly building solutions with partners that are value-based and focused on outcomes for the people we support and working for this to be in the most effective, efficient ways possible.


We added close to $10M in new growth with most being in the IDD arena; pursuing an expansion in school-age programs, which will enable a restructuring of education that is more sustainable; increased senior and executive leadership to 14 people while keeping administrative costs at 10-11%. Agency-wide recruitment initiative is underway, as well as training for managers.


Engaging in strategic planning with board and executive staff to look at best opportunities for IAHD, including merger/acquisitions and ways of assuming operations of failing programs.


Working with other CEOs (in multiple spaces—behavioral health, IDD, home health) to create structures (e.g., IPA’s) that will better position us for the future; investing in IT and new EHR’s and finance systems; exploring avenues for new or enhanced funding—and making the case for private philanthropy; exploring mergers and partnerships; examining ways that we can make our agency an even better place to work, while confirming whether our compensation is as competitive as possible.


We are working on a new timekeeping system which gives the DSPs the opportunity to decide what additional shifts they want to work and a way to request those shifts, offering them the opportunity to be paid out, quarterly, for the sick time they do not use during the quarter; incentives to bring in new employees and other incentive type programs. We work with the State on the reimbursement challenges, look for any ways to be more efficient (which there are few left); and look at new ways to generate additional dollars such as small businesses for our individuals, mergers or consolidations
with other agencies, etc.

What are some of the things you are telling your workforce?


HeartShare would not be able to sustain itself without the dedication of its 2,100 employees, which includes an incredibly diverse team of special education teachers, direct support professionals, youth counselors, physical therapists, physicians and nurses, social workers, addiction counselors, psychotherapists, and so many more. During my nearly 50 years at HeartShare, I’ve built and reinforced a culture of appreciation, including a family atmosphere at programs, a tradition of recognition, a policy of promotion from within, and support for professional development.


We are giving the workforce whatever is given to us by the State (this is a pass-through); we are looking at ways to reward them for their work, and we are asking them to rally around “Be Fair to Direct Care” campaign


I am as honest as possible with the MSC workforce. We have told them that we will do everything in our power to secure positions with the new care coordinating organizations—a new entity being formed in the IDD field that will control access to care.


We are doing everything to grow our agency and we want them (workforce) to be part of it.


Our workforce is engaged with all advocacy efforts on federal, state, and local level.


We are working very hard to be out in front of system changes and we have organized to be as nimble as possible to react to unforeseen changes.


Transparency (like honesty) tends to be the best policy. We try and keep our staff informed and engaged by letting them know what we (leadership) are doing at our level to be informed, and that we are creating platforms, structures, partnerships to be best poised for the future. We also need their feedback about their experience in the trenches and whether our (new) expectations are realistic.


I have been deliberate to say thank you via email, a personalized note or in person. I tell all staff to do their work to the best of their ability. Treat the folks we serve as how we wish to be treated. Stop operating out of a place of fear!

What are some of the suggestions you would make to change public policy in any one of the challenges you are facing?


I would suggest that the State keep the reimbursement rates at the level they are currently and give a trend each year.


Government does not need to dictate every step of each service provision. It is unrealistic that organizations shouldn’t be able to use revenue from one service to cover the other, especially when the profit margins are next to nil.


The loss of retained earnings with increases in programs operating at a deficit, and a narrowing of margins makes it very difficult to invest the resources needed to strengthen and retain the workforce.


Stop the unfunded mandates! My organization is already too lean.

What are some of the longer-range concerns you have that would directly impact your agency?


I’m very concerned about the direction of the healthcare industry. HeartShare has been preparing for managed care for several years now and we are ready. However, looking at long-term trends, it is unclear how non-profit providers will survive if we are being funded minimally, but are required to closely model ourselves after the structure of private health corporations.


The longer-range concern is the move to managed care and value-based payments. The individuals I support are very complex and our reimbursement rates are high. I am not sure that a managed care company would understand the needs and the reimbursement necessary.


I believe that small agencies like ANIBIC will need to merge or be absorbed.


Longer-term issue is a now an issue about maintaining leadership and securing the resources.


Medicaid reform and cuts could be severe.


The big issue is succession planning at both executive and board levels.


I am not convinced that the projected models for delivering service are viable fiscal models, at least as stand-alone agencies. . .and I am also unconvinced that creating VERY large organizations is the only right answer.


My primary long-range concern is with all the disruption coming to the field with managed care.

What are some of the positive forces working in the market place or government policy that will help your agency?

The extent of provider collaboration is unprecedented among agencies serving special populations. It also is one of the more innovative responses to market place pressures.

The combination of intelligence, practical experience, and strategic positioning puts the providers on a more solid footing to not only respond to payers and government policy changes, but also to be proactive in advocating for changes in public policy by introducing innovative solutions.

One of the more interesting benefits from these collaborations is the breeding of familiarity and collegiality among providers and their leaders. Why is this important? Many providers recognize that getting bigger is one of the solutions to being sustainable. They all understand that mergers are part of the shaking-out in the market place, especially when government continues to constrain funding.

However, merger is one of those words that scares boards and managers. As a result of the familiarity coming from collaboration, and the positive but realistic stories from other CEOs in the collaborative who have consummated several mergers, the lessons learned makes the possibility of merger more attainable or easier to consider.


Additionally, this move towards managed care also produced unprecedented non-profit collaboration. An example is the New York Integrated Network, which is a joint initiative of leading agencies that have a long history of providing individualized care coordination and long-term supports and services to individuals with I/DD.


I believe that OPWDD wants agencies like mine to exist so they will work to help support our existence. I believe that they want collaborations and will assist in that process. Large unions like SEIU Local 1199 that have a self-interest will also step up to help I believe. Telemedicine is also a positive strategy that should save money for both my agency and the State, thus another VBP opportunity.


Collaborations are ensuring the future of providers. It is possible that managed care can actually benefit providers by allowing more flexibility and creativity


Acuity-based resource allocation and pay for performance, but we have to have scale, creativity and ability to execute on value.


The policy support to undertake significant changes together through partnerships in behavioral health and intellectual and developmental disabilities, along with the promising value placed on integrated health care, provides encouragement that the significant work underway to create value-based integrated networks will be supported as an effective way to meet the expectations of the future.


Opportunities for additional collaborations and partnerships could lead to mergers and acquisitions. Affordable housing is a big initiative – looking at developing partnerships for new supported-living options for individuals on spectrum.


I am hoping the move to managed care will be a significant help.

What are you doing with your board on strategic thinking, positioning and planning?

The balance between professionalizing their boards while sustaining the commitment to the mission is pressing CEOs more than ever. The professionalization includes continuous strategic thinking and updating on public-policy changes, enhancing compliance and quality assurance, introducing metrics, and broadening selection of board members with new skill sets.

Many of these boards are a blend of parents and community representatives with the newer members who have been recruited because of their special abilities and experience, or because of their commitment to raise funds.


Each year, my board and I revisit our strategic plan, which is centered on succession planning and leadership engagement efforts. Similarly, we look to how we will grow and sustain our board by looking to cultivate young professionals who will become our next cohort of funders and advocates. We also work with board members to market our organization at their companies and within their networks. Brand recognition and reputation are as important for financial contributions.


We have a board committee that meets quarterly to discuss where we are going and what we need to do to be viable. There are monthly finance committee calls to continue to evaluate our financial position. However we have not yet begun to really look at managed care and its effect on us


I try to present the board with real scenarios about the future, including the possibility of merger.


Challenge includes aligning realistic strategic goals between board members and management and having constant and open communication helps.


The conversation with our board about the changes in health-care delivery and the significant preparation we are undertaking through partnerships, as well as our data-informed quality improvement process, occurs at every board meeting.


We engaged the board to be more strategic through collaborations and have put together a strategic planning committee of the board.


As a CEO, you always need to be transparent and keep your board apprised of what your agency currently faces and what lies ahead. Today’s environment puts the need to educate your board—and partner with your board—in neon lights. The entire board regularly includes conversations about positioning, planning, and strategic thinking.

Edited by Susan Morse

Design and layout by Kate Byrne Design |

Thank you to the following CEOs, listed with their affiliations:
William (Bill) Guarinello, President & CEO, HeartShare, and Chair of NYIN
Donna Colonna, President & CEO, SUS, and Vice Chair of NYIN
Amy Anderson-Winchell, President & CEO, ACCESS: Supports for Living, and Secretary of NYIN
Stanley Silverstein, Executive Director, IAHD, and Treasurer of NYIN
Shloime Reichman, Executive Director, Human Care Services for Families and Children, and Member of NYIN
Matt Sturiale, President & CEO, Birch Family Services, and Member of NYIN
Tom Lydon, President & CEO, Lifespire, and Member of NYIN
Susan Constantino, President & CEO of the Cerebral Palsy Associations of New York
State and Metro Community Services, and member of NYIN
Alan Trager, President & CEO, Westchester Jewish Community Services, and Member of NYIN
John DeBiase, Executive Director, ANIBIC, and Member of NYIN

Arthur Y. Webb
Owner and Principal of the Arthur Webb Group, Ltd.
Arthur Webb has over 45 years of experience in the field of health care and human services. He had almost 18 years as a public official in New York state government as a senior executive or commissioner of several government agencies including Acting Commissioner of the Department of Social Services (re-organized in the 1990s); Commissioner of the Office of Mental Retardation and Developmental Disabilities (now OPWDD); Executive Director of the Office of Substance Abuse Services (now part of OASAS); Executive Director of the Health Planning Commission (abolished); in the State Division of Budget where he was responsible for the Medicaid budget; and Deputy Commissioner for the State Department of Corrections.

As a provider, Mr. Webb was president and chief executive of Village Care of New York, and then served as the chief operating officer of the former St. Vincent’s Catholic Medical Centers of New York.

His client base includes a wide range of providers in the fields of intellectual and developmental disabilities, behavioral health, and long-term care. Mr. Webb serves on numerous advisory councils and task forces, and is a board member of nonprofit organizations.

One of the special services of the ArthurWebbGroup is the development and application of the Prager-Webb Dashboard, a joint venture with Prager& Co. in providing nonprofit, human service agencies a financial analysis of their financial strengths.

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