The Atrómitos Way

#055: Rural Health Transformation in Washington State and Beyond

The Rural Health Transformation Program [https://www.cms.gov/priorities/rural-health-transformation-rht-program/overview] (RHTP) is the largest federal investment in rural health in a generation: $50 billion over five years, distributed to all 50 states. Washington State received $181 million in year-one funding, with $5.43 million designated for The Rural Collaborative [https://ruralcollaborative.com/].  In this conversation, Michealle Gady sits down with The Rural Collaborative Executive Director, Elya Prystowsky [https://www.linkedin.com/in/elya-prystowsky-ms-phd-811b7819/], to cut through the noise about one of the most consequential rural health investments in years. They cover the stakes, the strategy and what comes next:  How has The Rural Collaborative helped Washington hold on to its rural hospital footprint while hospitals elsewhere have closed at alarming rates? What are Washington state’s specific goals for these funds, and how were they chosen? What do rural providers need to do before the 2030 deadline to ensure lasting impact? Elya Prystowsky has led The Rural Collaborative — a nonprofit serving 31 rural, independent hospitals in Washington State — for seven years. She brings 11 years of applied epidemiology and biostatistics and 15 years in healthcare, with a track record of translating research into practice. Key Takeaways Shared ownership over maintaining access. The RHTP’s $50 billion does not offset the loss of $137 billion in Medicaid funding — but organizations like The Rural Collaborative are pursuing every available avenue to help people maintain coverage and get the care they need. In Elya’s own words, “If one rural hospital closes in Washington, then we all collectively fail.” Collaboration takes energy and effort. Washington’s rural hospitals are already making strides: leveraging shared services, strengthening networks, and focusing on sustainability. Their principle— “Independence Through Interdependence” — is both the method and the proof of concept. Atrómitos Knowledge Hub Promo -- This podcast is a production of Atrómitos, a woman-owned boutique consulting firm creating a better way for our health and human services provider clients to achieve their goals by strengthening internal operations, enhancing financial stability and evaluating public policies. Want to know more about the firm behind the podcast? * Atrómitos, LLC Website: https://atromitosconsulting.com * Follow us on LinkedIn: https://www.linkedin.com/company/atromitos-llc/ * Subscribe on YouTube: https://www.youtube.com/@atromitosllc * Get Emails: https://atromitosconsulting.com/atromitos-way/#subscriber [https://atromitosconsulting.com/atromitos-way/#subscriber] In addition to our podcast, we've developed additional resources to improve your understanding of both long-standing and emerging issues important to leaders in the health and human service provider, government and philanthropic sectors. Our articles, policy briefs and infographics provide you with information you can use to reach your organization’s goals.  * Atrómitos Way Podcast Website: www.atromitosconsulting.com/atromitos-way * Follow us on LinkedIn: www.linkedin.com/showcase/the-atrómitos-way * Articles: https://atromitosconsulting.com/atromitos-way/progress/ * White Papers: https://atromitosconsulting.com/atromitos-way/unlocking/

#054: Innovations on the Ground: Building a Social Care Network

Healthcare often focuses on clinical symptoms and medical treatments, while many patients lack essential support for non-medical factors which greatly affect health outcomes. Social care networks aim to connect healthcare providers with community-based organizations to address the social determinants of health, such as housing stability, food security, transportation, and access to medical care. From early 2022 to mid 2025, Community Care Lower Cape Fear [https://carelcf.org/] (or CCLCF) saw firsthand what coordinated care can accomplish—and what happens when funding disappears overnight. On today’s episode, Atrómitos president, founder, and CEO Michealle Gady speaks with two leaders at CCLCF who are driving the efforts to build a robust and sustainable social care network with a new grant from the New Hanover Community Endowment. Michealle Gady has more than 20 years of experience helping health and human service providers, government agencies, advocates, and philanthropies create lasting community change. Sarah Ridout, MBA, SPHR is the Director of Community Programs for Community Care of the Lower Cape Fear (CCLCF) where she focuses on planning, implementation and program oversight of community programs within southeastern NC.  Dr. Michelle Jones has practiced Family Medicine in the Wilmington, NC area for over 26 years. She is a Past President of the North Carolina Academy of Family Physicians and has served as Medical Director of Community Care of the Lower Cape Fear for the last 5 years. Key Takeaways What happened? From pure cost savings, to a reduction in emergency department visits, to improved health outcomes, the HOP pilot had significant positive outcomes. Who benefited? Those outcomes weren’t limited to direct recipients. Every member served by the HOP pilot touched at least two lives, and most services supported whole households. What’s next? As CCLCF looks to the future to build a new social care network—one which aims to outlast any single funding source—what lessons can be learned from the HOP pilot? Want to learn more about CCLCF and the Social Care Network Initiative? Visit their website at carelcf.org [http://carelcf.org]. If you're interested in supporting this work, reach out to CCLCF directly at info@carelcf.org. Atrómitos Knowledge Hub Promo -- This podcast is a production of Atrómitos, a woman-owned boutique consulting firm creating a better way for our health and human services provider clients to achieve their goals by strengthening internal operations, enhancing financial stability and evaluating public policies. Want to know more about the firm behind the podcast? * Atrómitos, LLC Website: https://atromitosconsulting.com * Follow us on LinkedIn: https://www.linkedin.com/company/atromitos-llc/ * Subscribe on YouTube: https://www.youtube.com/@atromitosllc * Get Emails: https://atromitosconsulting.com/atromitos-way/#subscriber [https://atromitosconsulting.com/atromitos-way/#subscriber] In addition to our podcast, we've developed additional resources to improve your understanding of both long-standing and emerging issues important to leaders in the health and human service provider, government and philanthropic sectors. Our articles, policy briefs and infographics provide you with information you can use to reach your organization’s goals.  * Atrómitos Way Podcast Website: www.atromitosconsulting.com/atromitos-way * Follow us on LinkedIn: www.linkedin.com/showcase/the-atrómitos-way * Articles: https://atromitosconsulting.com/atromitos-way/progress/ * White Papers: https://atromitosconsulting.com/atromitos-way/unlocking/

#053: Mergers, Acquisitions & Strategic Options for Nonprofits in Uncertain Times (Part 2)

In part one of this conversation, our panel of experts discussed legal, regulatory, and financial concerns during transitions in the nonprofit sector. Today, on part two, the discussion shifts towards organizational culture and communication. Michealle Gady, Founder, President & CEO of Atrómitos, LLC, has more than 20 years of experience helping health and human service providers, government agencies, advocates, and philanthropies create lasting community change. Jacob Ferrari is a partner at The Apex Law Group, PLLC, and works with nonprofits at every growth stage including formation, application for tax exemption, board governance, and corporate exit plans. Michaela Kay is a CPA who serves as the practice leader for BDO's Seattle office, focusing on single audits, program specific audits, and financial statements audits for those in the life sciences, social services and housing industries. Julie Morris currently serves as Interim Executive Director at Wellspring Family Services in Seattle. As a professional interim leader, she specializes in helping organizations navigate periods of change and transition. Key Takeaways * Without for-profit shareholders, the traditional metrics for valuation don’t necessarily apply in the nonprofit sector. How should a nonprofit, and its assets, be valued during a merger or acquisition? * When it comes to finding complementary organizations, what does the “dating process” look like for nonprofits, and what can be expected during and after the “honeymoon” phase? Where do organizations stumble once the ink is dry? * What is the best way to navigate staff concerns during a transition? When should the conversation expand beyond board members to include staff—especially leadership—without kicking the rumor mill into high gear? Whether your organization is considering a merger, acquisition, or asset transfer, keep in mind that these decisions involve legal, financial, and operational complexity that most organizations don't navigate every day. Leaders striving for a smooth transition need to know when to bring in outside expertise, act from a position of strength rather than crisis, and recognize the human element of organizational change. If this episode resonated with you, please share it with your board, leadership team, or a colleague who might be wrestling with these questions. Atrómitos Knowledge Hub Promo -- This podcast is a production of Atrómitos, a woman-owned boutique consulting firm creating a better way for our health and human services provider clients to achieve their goals by strengthening internal operations, enhancing financial stability and evaluating public policies. Want to know more about the firm behind the podcast? * Atrómitos, LLC Website: https://atromitosconsulting.com * Follow us on LinkedIn: https://www.linkedin.com/company/atromitos-llc/ * Subscribe on YouTube: https://www.youtube.com/@atromitosllc * Get Emails: https://atromitosconsulting.com/atromitos-way/#subscriber [https://atromitosconsulting.com/atromitos-way/#subscriber] In addition to our podcast, we've developed additional resources to improve your understanding of both long-standing and emerging issues important to leaders in the health and human service provider, government and philanthropic sectors. Our articles, policy briefs and infographics provide you with information you can use to reach your organization’s goals.  * Atrómitos Way Podcast Website: www.atromitosconsulting.com/atromitos-way * Follow us on LinkedIn: www.linkedin.com/showcase/the-atrómitos-way * Articles: https://atromitosconsulting.com/atromitos-way/progress/ * White Papers: https://atromitosconsulting.com/atromitos-way/unlocking/

052: Mergers, Acquisitions & Strategic Options for Nonprofits in Uncertain Times (Part 1)

With many nonprofits facing existential threats due to revenue loss, federal funding freezes, and policy shifts, organizations are forced to operate on reserves while waiting for clarity that may never come. Now more than ever, it is crucial that nonprofits reframe their views on mergers and acquisitions—as well as the many alternatives. On today’s episode, Atrómitos president, founder, and CEO Michealle Gady is joined once more by Michaela Kay of BDO and Jacob Ferrari of Apex Law Group. Julie Morris, interim executive director of Wellspring Family Services, rounds out our panel of experts to discuss the complexities of nonprofit mergers and structural changes in the current challenging landscape. Want a refresher on Michealle, Jacob, and Michaela and their conversation detailing the report on the sustainability of human services contracting in Washington state? Listen (and read) here [https://www.buzzsprout.com/2246285/episodes/18107371]. Julie Morris is the Interim Executive Director at Wellspring Family Services [https://wellspringfs.org/] in Seattle, WA. As a professional interim leader, she specializes in helping organizations navigate periods of change and transition. Julie has practical experience leading a nonprofit through a program and asset transfer and is deeply committed to solutions that prioritize community impact and long-term sustainability over organizational ego. Key Takeaways * What are our experts seeing right now in terms of organizational stability and financial health in the nonprofit sector, and when should a nonprofit leader start considering structural changes rather than weathering the storm? * What's the difference between a merger, an acquisition, and an asset transfer in the nonprofit context? When do the alternatives—such as fiscal sponsorship, management services agreements, collaborative partnerships—make the most sense? * What does financial due diligence look like for nonprofit transactions? How do restricted funds and grant obligations complicate these transactions? This episode is part one of a two part deep-dive, so be sure to tune in next month to hear the rest of this conversation. If you’re an executive director listening to this episode and thinking, “This might be us,” you won’t want to miss it. Atrómitos Knowledge Hub Promo -- This podcast is a production of Atrómitos, a woman-owned boutique consulting firm creating a better way for our health and human services provider clients to achieve their goals by strengthening internal operations, enhancing financial stability and evaluating public policies. Want to know more about the firm behind the podcast? * Atrómitos, LLC Website: https://atromitosconsulting.com * Follow us on LinkedIn: https://www.linkedin.com/company/atromitos-llc/ * Subscribe on YouTube: https://www.youtube.com/@atromitosllc * Get Emails: https://atromitosconsulting.com/atromitos-way/#subscriber [https://atromitosconsulting.com/atromitos-way/#subscriber] In addition to our podcast, we've developed additional resources to improve your understanding of both long-standing and emerging issues important to leaders in the health and human service provider, government and philanthropic sectors. Our articles, policy briefs and infographics provide you with information you can use to reach your organization’s goals.  * Atrómitos Way Podcast Website: www.atromitosconsulting.com/atromitos-way * Follow us on LinkedIn: www.linkedin.com/showcase/the-atrómitos-way * Articles: https://atromitosconsulting.com/atromitos-way/progress/ * White Papers: https://atromitosconsulting.com/atromitos-way/unlocking/

#051: From Crisis to Sustainability: Reforming Human Services Contracting in Washington State

In 2024, the Department of Commerce contracted with Atrómitos to answer a critical question: are the contracting structures in Washington state sustainable for human service providers? The findings of that nine-month study are sobering, and today’s episode of the Atrómitos Way is a deep dive into not just the contents of the report, but the wider implications for communities and a potential path forward for human service providers of Washington state. Michealle Gady, Founder, President & CEO of Atrómitos, LLC, is a policy strategist with over 20 years of experience driving systemic change in health equity, social justice, and community empowerment. Michaela Kay is a CPA who serves as the practice leader for the BDO [https://bdo.com/] Seattle office, focusing on single audits, program specific audits, and financial statements audits for those in the life sciences, social services and housing industries. Her two years working for World Vision as a lead senior accountant provide her with the ability to understand and relate to her clients on a practical level. Jacob Ferrari is a partner at The Apex Law Group [https://apexlg.com/], PLLC. His primary practice works with nonprofits at every growth stage including formation, application for tax exemption, board governance, and corporate exit plans. He regularly speaks and serves on committees effecting the nonprofit community and works to better the nonprofit regulatory environment. Jacob’s goal is to care for his clients as much as his clients care for the community around them. Key Takeaways Financial crisis: Cost-based reimbursement, inadequate indirect cost rates, and delayed payments create a "starvation cycle" that prevents providers from investing in staff, infrastructure, or building financial reserves. Structural barriers: Complex applications, inconsistent requirements across agencies, limited negotiation opportunities, and extensive compliance burdens disproportionately impact smaller, community-based organizations. Human impact: These systemic issues result in high staff turnover, barriers for "by-and-for" organizations serving marginalized communities, and the risk that qualified providers cannot afford to contract with the state despite clear community need. The full report is available on the Washington State Department of Commerce website and at atromitosconsulting.com [http://atromitosconsulting.com]. Whether you’re a human services provider, a legislator or policymaker, or just a concerned member of your community, please reach out to your elected representatives and let them know these issues matter. Atrómitos Knowledge Hub Promo -- This podcast is a production of Atrómitos, a woman-owned boutique consulting firm creating a better way for our health and human services provider clients to achieve their goals by strengthening internal operations, enhancing financial stability and evaluating public policies. Want to know more about the firm behind the podcast? * Atrómitos, LLC Website: https://atromitosconsulting.com * Follow us on LinkedIn: https://www.linkedin.com/company/atromitos-llc/ * Subscribe on YouTube: https://www.youtube.com/@atromitosllc * Get Emails: https://atromitosconsulting.com/atromitos-way/#subscriber [https://atromitosconsulting.com/atromitos-way/#subscriber] In addition to our podcast, we've developed additional resources to improve your understanding of both long-standing and emerging issues important to leaders in the health and human service provider, government and philanthropic sectors. Our articles, policy briefs and infographics provide you with information you can use to reach your organization’s goals.  * Atrómitos Way Podcast Website: www.atromitosconsulting.com/atromitos-way * Follow us on LinkedIn: www.linkedin.com/showcase/the-atrómitos-way * Articles: https://atromitosconsulting.com/atromitos-way/progress/ * White Papers: https://atromitosconsulting.com/atromitos-way/unlocking/