1. 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)

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

3.  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

4.  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

5.  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

6. 1983-1997 Care for Dying 1998-2003 Care for the Living 2004-2009 Connected to Care 2010-2013 Improve Health Outcomes Crisis/ReactiveResetProactivePrepare for Future GrassrootsBuild SustainabilityExpand VerticalBroaden Horizontal Client ComfortClient SupportClient Stabilization Client Independence $ High$ Decrease$ StabilizedNew $ Sources Strategic Plan

9.  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

10.  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

11.  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

12.  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

13.  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

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

15.  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

17.  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

19.  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

21.  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

22.  Lack of culturally competent care, quality care  Secured Part C grant; ARCW Medical Clinic opened 20012015 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

23.  Limited access to mental health for patients  Joint grant with FQHC 20032015 StructureSubcontract recipient Employ all staff Grant recipient Employ all staff Staffing2 Therapists2 Psychiatrists 1 Psychologist 7 Therapists 3 AODA Counselors LocationsMilwaukee7 locations Patients14646

24.  Lack of integrated care; unrealized revenue  Opening of ARCW Pharmacy 20112015 StructureSubsidiary for-profit LLC Staffing2 Pharmacists 1 Pharmacy Tech 5 Pharmacists 7 Pharmacy Techs 3 Pharmacy Interns LocationsMilwaukee Patients4172,468

25.  Doyne Hospital and its dental clinic closed  ARCW Dental Clinic opened 19972015 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

29.  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

30. 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

31. 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%

35. 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

36. 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

37.  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: www.nationalhivcenter.org.www.nationalhivcenter.org  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: www.nationalhivcenter.org)www.nationalhivcenter.org Conclusion Slide