 All right, well, why don't we go ahead and get started? I want to just start off by saying welcome. Thank you so much for attending our session. We are really excited to be participating in SOCAP. It's such an energizing gathering, and especially during the COVID pandemic. It's really nice to still have this opportunity to connect. I'll start off by introducing our panelists. Today, we have Kimberly Black King, she is Senior Vice President of Housing Development with Volunteers of America National Services. Volunteers of America National Services is a national nonprofit organization that advances, supports, promotes, and administers health, housing, and supportive services. We have Andy Phillips, co-founder and managing partner of Make Home Capital, a new impact investing platform under which she is launching the Community Outcomes Fund, the first U.S. Outcomes-Based Financing Fund. We also have Andrea Ponzer, CEO of Stewards of Affordable Housing for the Future. SAFE is a nonprofit collaborative of 13 multi-state nonprofit affordable housing providers who own more than 140 affordable rental homes. We have a slight change to our panel today. My colleague, Andy McMahon, had a last-minute conflict and is unable to join us. So I will be moderating today's session and also filling in with United Health Care's perspective. So I'm Eleanor Bieber. I'm Director of Social Impact Strategy with United Health Care Community and State. United Health Care Community and State is a division of United Health Group that provides high-quality public sector healthcare programs in 31 states and Washington, D.C. So we're interested in hearing where you're joining from. So if you'd like to, please feel free to put that in the chat. And then also we plan to save time at the end for questions. But please put them in the chat along the way so that we can get to as many of them as possible. For our session today, we'll focus on building investment partnerships between healthcare housing and social service organizations with the goal of improving health in communities. There's growing evidence of the important role of social determinants of health and wellness, of social determinants of health and health and wellness. It's estimated that about 80% of health outcomes are attributable to the social determinants of health. And that's broadly defined as health behaviors, socioeconomic factors, and environmental factors. So things like housing and employment and social support are important to health and well-being. And during our session today, we'd like to share examples about how we are currently collaborating together to improve health in communities, discuss health-focused cross-sector partnerships, highlight healthcare as an investor, and then share early lessons learned, including how COVID-19 has impacted this work. So with that, oh, and it's great to see all the chats of where everyone's coming in from. To our panelists, I'd love if we could go around and if you could tell the audience a little bit more about your organization and your role. Kimberly, why don't we start with you? Getting off mute as step one. So good afternoon, everyone, or morning, depending on where you're based. So Kimberly Black King, I'm our Senior Vice President for Real Estate Development and Volunteers of America National Services, Vones for short. So Vones, as Eleanor said, is a nonprofit and we're a faith-based nonprofit. We are national in our scope. We develop and own affordable housing. So that is housing for low-income individuals and seniors and families. We have housing that is dedicated to folks with special needs as well, and we have a focus on veterans' addition to that. The other side of our business is a healthcare line. So we provide healthcare to seniors. We operate over 40 healthcare programs. And that ranges from skilled nursing facilities to assistant living to PACE programs to adult daycare. There's a whole range of programs. So I am on the housing side and we recently have sort of worked to break down the silos between our housing and our health care side so we could share that expertise. My team actually just oversees the sort of bricks and mortar components of the development. So from soup to nuts, getting an acquisition or new development, new construction built to stabilization, losing it up. And once that's done, we turn it over to operations. What we're starting to do now with our team is connect more with our healthcare side of the business and make sure that we have healthcare outcomes that are identified early on and targeted for our new developments. Thank you, Kimberly. Andrea Ponser, would you like to go ahead? Sure. I'm Andrea Ponser. I'm the CEO of Stewards of Affordable Housing for the Future. We call ourselves SAFE. And as Eleanor said, we're a collaborative of 13 very large nonprofit affordable housing developers including Volunteers of America. Our members own about 148,000 rental homes at about 2,000 properties around the country. They're in every state except North Dakota, Puerto Rico, the Virgin Islands, and Washington, D.C. Here at SAFE, we bring together those members and lift up the best practices and policy ideas for creating and preserving homes that connect people to opportunity and well-being. So that means drawing on practice to understand what the challenges are to both creating homes and having people flourish there. And with that, we make policy recommendations not just in housing, but where housing connects with health. Thinking about how you can use service coordination and partnerships across sectors to give people the opportunity to close some of the equity gaps we see in so many communities. So we do that by working with funding partners, with Congress, with federal agencies, and lifting up practices at the state and local level as well. Thanks, Andrea. Andy, would you like to go ahead? Sure. Thank you, Eleanor. And thank you for sort of pulling together this wonderful panel, even if Andy McMahon couldn't be the third version of the name Andrew or Andrea to be on this panel. So Make Home Capital is an impact investing platform. I launched the Community Outcomes Fund at Make Home Capital about four years ago after spending six years at Goldman Sachs where I both led Goldman's social impact bond investments, what I would now call Outcomes Financing, as well as Goldman's social impact fund. I decided to launch this new fund because I really believe in the power of harnessing public-private partnerships to address investments in human capital rather than just physical infrastructure. I think Eleanor did a great job at the beginning of the panel really talking about the social determinants of health. And that is really what our goal is, is to work in communities to help expand high-quality human and social service programs to help folks access economic opportunity and address poverty. The goal is really to align local spending with social outcomes and using private capital, as we've seen for decades in the housing space to drive social impact. We are doing the same in the social and human services arena. As I said, I launched the fund about four years ago and I am very pleased to share with the SoCAP audience today that United Health Services has now made a $10 million commitment to the fund joining about 12 other limited partners bringing us to a total of around $60 million of capital. So we are very excited about this partnership, not least because we really feel like as we began talking about United investing in the fund what was immediately clear to us was the alignment of our goals around addressing the social determinants of health and a commitment to really partnering with local communities. So excited to be able to share that today. Wonderful. Thank you, Andy. I'm having a little bit of trouble with your audio but I think it's just my connection. So hopefully it'll pop back in soon. If not, I may try to exit and enter at a specific point but so thanks everyone. Lastly, I'm Eleanor Bieber with United Health Care Community and State and Community and State serves Medicaid population so that primarily folks who are low income, both individuals and families, seniors, people with disabilities and people experiencing homelessness are really a wide, a very diverse population. We have about six million members in states across the country. In my role, I work with our health plan leaders on developing partnerships that address social determinants of health and also with our United Health Group Treasury team on our social impact investment work. And we're working to invest dollars in initiatives that improve health in communities. We have a longer history of investments in affordable housing. I continue to have a strong commitment in that area, but we're in the process of expanding that portfolio and we feel really fortunate to work with such great partners, SAFE and VOA on our recently announced health and housing fund and then of course also with Andy Phillips on the Make Home Community Outcomes Fund. I'm really excited for this conversation. First, let's dig a little bit deeper into the topic of health and housing. Andrea and Kimberly, you touched on this a little bit in your introduction, but how do stewards of affordable housing for the future and volunteers of America think about the connection between housing and health? I can start, if you want. That would be great. As a collaborative of real estate developers, we were pretty early to recognize that housing is a fulcrum for health, that you can leverage in other interventions to improve health if you just have a stable home. Housing instability itself, including things like being behind on rent, having multiple moves or ultimately becoming homeless, is associated with a host of adverse outcomes. For instance, if you lack affordability and a family moves into crowded conditions, you start to see kids with impacts, higher risk for injuries, blood pressure, respiratory conditions, and exposure to infectious disease, much like what we're seeing play out right now with COVID-19. And on the flip side, we found the children or it's been found that children in low-income families that get housing assistance are more likely to get access to adequate nutrition and perform well on well-child visits. So we're real estate developers, and when we think about all of this, we begin with affordable homes. And we come together to think about those practices that help us leverage housing into other things that support well-being. So we're trying to think really systemically, not just anecdotally in how you connect people. There are a lot of great partnerships out there thinking about, okay, well, we have housing and we can bring in some health care but that's wonderful. But we want to ask the question of how can you use the scale of rental housing, not just having 50 or 100 or 200 families in one place, but what if you owned a portfolio all over the country? What could you do to really start unlocking partnerships? There are certainly opportunities to reduce health care costs, and our members are working on a lot of those through partnerships that bring in both preventative care and things that are more responsive. But we're trying to really think upstream to those social determinants of health, what are the ways they connect to home. So that's stability, education, community safety, sense of agency, and the support of the community as well. When we think about stability, we think about the affordability of the home but not just what the rent is, things like how high are your utilities? Is your home stable and comfortable and can you afford to keep it that way over time? And this is a place where we're finding new partners like United Health Group and others every day to provide new resources to create just more units of affordable housing. Then we think about how healthy is that housing? What are the materials we use to build it? And what is its impact on the surrounding community? What are the carbon emissions? How does it contribute to population health? And then how we connect people to other supports. And that's where we're forging a lot of partnerships right now. You can do that just by locating housing well where there's a lot in the community but also by bringing in service coordination and someone that can help people connect to what they need and close some of those equity gaps in communities that have been disinvested and disconnected by centuries of systemically racist policy. And that can be connecting people to preventative health, nutrition supports, education after school programming, financial coaching and whatever else they need and where the community is lacking or can provide something just with that bridge. But this hasn't been something that's been paid for. So we think a lot about how do we bridge that gap and create health by providing that connective tissue between residents and community. We've about six years ago started a community of practice that came up with a framework of how do we as property operators think about this and build this into our DNA. So we're thinking constantly about how you serve residents starting first with what they tell you they want. And then once you have that in place also measuring outcomes. Out of that we started thinking about and we now operate a certification program that thinks about how do we identify those partners that are doing this on a systems level and being accountable for the outcomes they're creating. And this focus on that intersection of health outcomes and healthcare data but a more holistic sort of sense of things is what's helped us forge partnerships not just with United but members are working with other payers on sort of more localized partnerships and then we're also working with Fannie Mae on an outcomes-driven partnership to provide that service coordination factor. Thanks Andrea. Kimberly, how about for you with Volunteers of America? We work very closely with SAFE as Andrea said we're one of the members of the SAFE Coalition so we work very closely with her so I echo a lot of her comments and we agree that there's an absolute connection and that housing is one of those core essentials and it's very difficult to focus on some of those other issues when you don't have stable housing. And the communities that we serve we typically serve underserved communities so we're seeing those elements of a lack of leading with the lack of access to quality affordable housing along with high unemployment education for nutrition health deserts food deserts all of those things in the communities that we serve so that's never a surprise for us. I think that historically we have talked about health and housing being so connected that people will say housing is health care or housing is a prescription for health care and we fully agree and subscribe to that but now we have to really sort of figure out how do we demonstrate and as Andrea said how do we pay for some of these things so our real focus is on how do we expand our partnerships and we think it's absolutely necessary for us folks in the affordable housing industry to think more broadly about who we're partnering with. I've sat on the real estate side for 20 years so when I think about who my partners are they are capital partners to help me get a building built right so they're baits they're investors but we really have to think about if we're going to partner with some of these adjacent sectors who some of those more unusual suspects are then maybe very good partners so for example we partnered with AARP to do a demonstration to demonstrate how Alexis could help address social isolation and some of the adverse health outcomes that we see with seniors who are you know social isolate in their units and our portfolio is about 70% seniors so there's research that shows that Alexis and similar tools like that are used as companions right so that AARP is not of a very sort of organic natural partner that would come to mind for us but it is an awesome opportunity so you know here we are thinking about not only how we can address the health outcome for our residents but it also got us thinking about how we're going to serve our residents in the future and how technology may change so in short we wifi retrofitted some of our buildings to wifi throughout the building drop Alexis in the units and this enables us to engage with the residents differently right so we've long gone are the days where we put a flyer on and the residents door and say senior yoga at one o'clock you know now we have to be much more engaging so we can say hello Kimberly don't forget senior yoga is today at one o'clock senior yoga is in 30 minutes you know we can hear from property management that the number one call that they get is the mail there yet and so we can say with the flip of a switch Kimberly your mail is here those things are very helpful to keep they sound small but they add up and they're helpful in keeping residents engaged and and moving and addressing that isolation so partnerships that we're thinking about as we expand on you know beyond we know that there is an absolute connection but how do we build and bring some of these things to scale mm-hmm thank you so and I think especially you can really touch on this a little bit in your answer already but how has you're thinking around the connection between housing and health how your organization thinks about it how has that changed over time in terms of the partnerships you're thinking about or you know even having it as a priority you know with from a healthcare lens I think for us it's newer to think about it in those terms can really say housing is healthcare I think that's something that we're thinking about too I'm curious if this is something that's you know been true for a long time with your organizations or if this is kind of newer partnerships or newer priorities that you're so some of the partnerships are new but the concept is not as I said earlier so we have housing expertise on one side of the organization and healthcare expertise on the other and we have for years operated in that way and healthcare did its thing so it wasn't it was more by sort of coincidence that we would create some great you know model that we would be working together but it wasn't intentional so I think that the intent and the focus on it as a minority is what's changed over time so we've always there are very positive healthcare outcomes with housing we have about 130 resident coordinators providing services to about 160 of our senior buildings so we have a lot of data on how effective the resident coordinators that do things like provide assistance to getting benefits coordinate activities with residents so they do all of those broker providers to come in and do some preventative care things so about 95% of our residents participate in our resident coordinator service program we've seen our retention rates at 86% for our residents that are able to age in place so we know that our residents are staying healthier longer so it's information that we've had two things that we've asked ourselves if we know that model works and it's important then how can we bring that to scale our resident coordinators are paid with HUD grants and we don't have that access in all of the properties that we're going so we have over 500 properties so we don't have the access to HUD funding for all of those so the question is, okay what sort of partners do we need to have at the table so that we can bring this very useful asset to our projects and so we did a couple of things over the past 18 months to help this come to fruition one, we hired a vice president of housing and healthcare initiatives and so this was a recognition that I do real estate healthcare, people do healthcare we need somebody to help tie it together and so that's her role so before we age on any project the real estate development team sits down with her and we start talking about the neighborhood that we're looking at we talk about the most recent community needs assessment that was done in that neighborhood to see what the needs are who's currently providing services where the gaps are who some potential partners might be and how we might want to design that space to incorporate those partners so that's one thing which has been really great the other thing we did in February our board approved our most recent strategic plan and it has four goals the very first goal is innovative housing and healthcare the second is well-being the third is partnerships so the partnerships is really designed to help us achieve the innovative housing and healthcare and the well-being which we are putting metrics around what that means and then the fourth is dedicating resources to our infrastructure to make sure that we are prepared to achieve these goals so our board has really put and senior leadership has really put a lot of effort and commitment behind it and that means a lot so the organization is on the same page and that means a lot in making sure that we're able to achieve our goals I'll mention one other thing that that we did as well we had Andrea mentioned or it may have been you Eleanor that mentioned the health and housing fund so that's one of the things that we're starting to think about historically on the real estate side of the house we've raised capital for acquisitions of development sites and things like that buildings for our app rehab but not necessarily intended for health and housing outcome initiatives so I'd say that's the third thing that we're being very intentional about and that's a great segue Kimberly Andrea I'd love if you could maybe share a little bit about the health and housing fund that we recently launched sure so this is a partnership between SAFE our affiliate organization the national affordable housing trust that syndicates low income housing tax credit investments so these are credits that are available to developers like Kimberly when they have a property that will serve people of modest income for a period of 30 years and those tax credits can then be syndicated or sold to investors that are looking for that tax benefit over time and interested in having an impact on how their dollars are spent this fund is a hundred million dollar investment by united in those tax credits to contribute to the building of affordable homes but in addition to that and this has happened before this is not united's first foray into this space and there are other health care actors doing similar things what is very unique about this fund though is the investment that has been made in resident services that goes with it all the properties in this fund will be invited to submit proposals for additional funding that helps catalyze unique resident services that improve the wellness and well being of people living in these properties my organization safe is administering those funds and helping organizations craft those proposals and think about how we're going to track outcomes so Eleanor and I will be working together for the next five or six years watching how life is going for the people living in these properties they come online and these service innovations come into being we've identified four or five core outcomes and this builds on work safe has been doing over the last five or six years our members are collecting outcomes how life is going in terms of access to health care how life is going feelings of safety in the community income employment housing stability it's five categories twenty five measures being collected across our portfolio and we've drawn on that experience to build a much smaller set of outcomes that we're looking at for different measures being implemented through the fund. Thanks and I just to add on to that a little bit I think you really called out the things that were most excited about with the fund being the the dollars available to support services you know you had said that that's one of the things that there sometimes isn't enough funding for there is there are not dollars available for and you know I think we're aligned in our you know mission and prioritizing both housing side but also what in addition beyond that can help support health and help the residents be as healthy as possible and then also to that you know evaluation structure and understanding you know what is the impact I think there's you know there's strong literature there's evidence about the impact of housing on health understanding the impact of this work specifically including the you know the interventions and the additional projects the services fund is really really exciting to us. You know I think it's important to note to that and we're really excited to see that United has taken a broad view of this and said like look don't just think you hire a coordinator and it has to be this and they're going to take blood pressure really take that resident-centered approach and think about what the community needs and it might catalyze other partnerships and so we look forward to seeing as these properties come through the development pipeline a dozen or more of them in the next couple years what folks will come up with and what benefits we'll see from residents and creative ideas. Great well let's change gears a little bit and turn our attention to pay for success interventions specifically those impacting health Andy I'd love to pose a few questions to you and then I think what I'm going to do because my audio I'm still not able to hear you I'm going to duck out and sign back in while you're answering and hopefully then we can continue the dialogue so I'd love to hear I'd love if you could share with the audience what are the interventions that have been tested in a pay for success format that show promising results for health and then also if you could tell us a little bit about the community outcomes fund and how we're partnering together. Sure thank you Eleanor and good luck so there are a number of interventions where pay for success has been successful that are related to health and I can talk about a few examples some are sort of direct health interventions and others are really more broadly addressing the social determinants of health but if you take a step back success Eleanor nope if you take a step back and think about what do we mean what is the goal of pay for success it's really tied to the fact that government is the largest purchaser of services for people who are poor and disadvantaged estimates put that spend at 800 billion to a trillion dollars and that is with a democrat in the white house with a republican in the white house it really stays at that level of scale. The problem that pay for success in outcomes financing seeks to solve is the oftentimes disconnect between how those dollars are spent and the actual impact and goals and using the structure of a public private partnership to align those things we're used to these types of structures when government wants to build a bridge right they enter into an agreement with the private sector the private sector builds the bridge and then the government the sponsoring government pays the use fee for the next 35 years or an availability fee that then repays the investment of the private sector but if the bridge isn't there the sponsoring government doesn't pay. Oftentimes when people talk about funding human services they talk about it as a pay and pray model where government enters into a contract based on a budget and the dollars flow based on how much money is spent rather than whether or not the intended impact has been achieved. So we really launched the community outcomes fund to help bring the capital to communities that would enable these new public private partnerships or relatively new. Circling back to healthcare when you really think about the social determinants of health and sort of what you really want to do with the public sector. So we have a lot of investment. Most of our projects if not all are related to addressing issues around health. We have finance for example the expansion of pre-K in Memphis and Shelby County where we're providing high quality pre-K to about a thousand low income four-year-olds. And then we have the more better adherence to preventive health care visits. More likely to have a medical home. So you're seeing both those short and long-term very direct health impacts. Additionally tying it back to COVID one of the key parts of this pre-K model is also to include health services. It's considered best practices in pre-K that it's not just about the four-year-old but it really needs to be about the whole family. And what those wraparound services providers are doing in addition to broadly supporting the family is they're connecting that family to health services and health screenings. Really important come last spring is tremendous food insecurity having very real near-term health impacts. But that family service worker that really is part of the pre-K program was helping to address some of those very direct health issues. So I think that's a great example of how we're thinking about it in terms of the social determinants of health and where there are opportunities that both change somebody's trajectory in terms of helping folks build the building blocks to move out of poverty but also more directly impact health. Another example is around home visiting, right? There's a tremendous amount of evidence that talks about how home visiting for at-risk mothers both sort of prenatally and in the sort of immediate period postpartum can make a tremendous difference in terms of getting building a foundation for health for that child through well-child visits and through addressing maternal depression. Yet in spite of that evidence, what we know across the country is that there is tremendous unmet need for home visiting services. We're working in a few jurisdictions right now with partners on the ground including hospitals and home visiting programs and local and state government to help scale those programs. Again, there is a very clear link to less caesarean births less low birth weight births but also many of the much broader impacts in terms of those families. I also want to sort of circle back to the housing issue because I think housing provides an interesting platform as you could say. In part because, you know, as Andrea and Kimberly have both very eloquently talked about, housing is sort of a fundamental and I think some of the opportunity that we have not quite taken advantage of enough is how to help families that have the benefit of safe and affordable housing use that to as a sort of springboard for accessing economic opportunity and I'm happy to say we are partnering with some progressive affordable housing developers to really talk about how in that moment when you are building the building, how can you think about outcomes financing as a tool to also invest in if it's a rehab the people who are living in that building or if it's new construction the folks in that community and help them get access to better jobs whether through the construction that's going on for the project or other jobs that are in existence for the community and we think that particularly when you're thinking about families here in New York City over 50% of adults in New York City public housing are unemployed there is incredible room to have an impact and so one of the things we as a team are exploring is how do you look at that nexus between affordable housing and human services and social services to really use that as a holistic way of helping people to understand that I agree 110% and we are seeing a lot of our partners and I mean our peers focus in this area you know I think it was one of our safe meetings one of our peers said that they are now doing some trauma informed care training for their property managers which I thought was phenomenal and even thinking about moving that same sort of training to their development team so that it is important to know who our clients are and who we're building for and our goal is to really help rebuild communities and so it's not just about having the family or the senior in their but it's about the whole nexus as you said and so I think that you know I'm glad that you added that point I think that that's a great point for us to make sure we double down on Yeah I think moving forward ideally when folks think about developing affordable housing whether it's for seniors or for families or for at risk individuals that within that financing is not just the bricks and mortar and that we can no longer afford to say the services are sort of a nice afterthought that we're going to get foundations to come in and pay for we should be using the same investment approach when it comes to investing in the people who live there. I think that's absolutely right and you raised a really good point about sort of thinking about the construction and rehab process too and how you talk about the people that live in the community and understand what it is they need one of the challenges for really transformative affordable housing development has been no one wants to pay for that early work and that is hard work that takes a long time and so having an expanded group of actors thinking about how do we wrap that into financing and how do we understand that work and how do we share what we're doing across platforms too because it's not the housing developers not the only one doing that work and in good place-based collaborative it's it happens everywhere so how do we really you know we're thinking a lot about how do we build that skill in our organizations for every transaction not just the one that has this great collaborative because we're trying to change a whole neighborhood at once but how do every time we ask this question and how we leverage this moment we're thinking differently about building housing and having to take new approaches because we're in this pandemic moment and that may create opportunities for thinking about new jobs are we going to use more modular construction or more offset you know framing or can we move at a different pace or in a different way so I think there's a moment of both challenge and opportunity here I'm curious Andrea to that point how COVID is impacting your work now you know you said it's a new moment this is obviously to use the cliche unprecedented times how is COVID impacting your work in affordable housing so I mean I think like everybody's how isn't it impacting it really in some ways it's confirming things we always knew right how important a stable home is that if you can be stable and uncrowded your risk of infection and a bad outcomes if it does happen is lower we are seeing this value of service coordination just really play out I think Andy raised food insecurity at the beginning of the pandemic the role service coordinators and that our members and their management companies mission driven owners played to step in and just make sure that people had food on their plates was enormous and then it became helping people figure out how do I apply for this unemployment and am I applying for the right unemployment and can I get a Alexa because I'm lonely and my grandkids can't visit anymore having that that focus and that person and those connections to community institutions that can help fill those gaps have been really important on the development side it's in Kimberly can speak more to this as well we saw some initial slowdowns not only because people couldn't work on site we're now starting to see some of that manifest in supply chain disruptions there were some early ones but we're now seeing sort of later stage in disruption as well and there's been a sort of evolving challenge with state and local government partners who are working nonstop to try and meet the different COVID demands that are also evolving to processes that were never meant to be remote like hearings and community engagement becoming remote and an unprecedented strain on their resources all of that good gap funding and housing incentives and tax abatements are now in jeopardy as communities just don't have the resources they need to meet the public health crisis so there's a lot of creativity and good partnership happening there but I think really you are seeing the value of mission driven and service enriched housing right now in a way that you know we couldn't have written a case study this good in some way unfortunately you know this is how it played out yeah and it's still playing out and you know this is you know I think we'll be in this environment for a while and it's certainly whenever that happens it definitely creates some uncertainty in the financing market so you know it's hard to sort of predict what that will look like when we are you know have no idea what the pandemic looks like over the next many months so that's challenging you know we had we had many senior projects we have projects underway that were actually under construction when in March when we went remote in response to the pandemic and you know we I think we responded really well we learned a lot again from our health care side so in terms of some of the protocols that they were putting in to protect the residents but you know what is a stressor for me that we talked about earlier is the social isolation piece and our seniors are you know they've gotten a little worked up with that and a lot of sites are very very active which is a great thing and it is exactly the opposite of what we want them to do we want them to be socially and physically distant so it's been really difficult we have some really great property managers that have done balcony socials and out the window socials but it's not the same but we're doing our best I am sure that we will see many design standards come out around COVID that looks like we will never build another senior property without a balcony or air flow there are going to be things that are just staples as a result of COVID but it's here with us for a while but I think that there's what is it no good crisis goes to waste or something close to that and so it has forced us to do things that were on our list of things to do but maybe not the top priority and so we've been very effective and I think that that will then allow us to do more with less so we already operate with a lean machine and now we do even better with a lean machine because we went remote and started using all of these tools that we had so we had access to zoom nobody ever really used it and so now we've become so creative that we're doing I have construction managers that are doing monthly draw meetings remotely so they're able to Skype it or FaceTime to the site versus going to the site which is travel expense which is time and actually a real field observation so they can do that in other ways now you wouldn't want them to do that for 12 months straight right but do they need to go every month so we've started to get really creative in ways that we can be more efficient with how we work which will allow us to be more productive so I think from an organizational standpoint we're really excited to to build on that and not you know let this sort of terrible time sort of lose that opportunity in this time that we've been working on mm-hmm you know I'll talk on one quick thing that Kimberly sort of brought to light which is digital inclusion we have for a number of years been saying you know we need to think more about this and the extent to which residents of affordable housing don't have the same access to high speed internet at home that other people do if they have it they're reliant upon a smart phone and then one day we all went home from work in school and it's been eight months and if you don't have a dog parking lot not a community center your ability to access healthcare to socialize to go to school to do work to get income supports and nutrition supports is all compromised so we are thinking in a much more accelerated way to about how we build that in and make sure that everybody in a building can have that and about how it pays for itself and Kimberly I think talked some about ways that owners can interact with folks digitally to and provide notices well you can do that with rent recertifications and renewals and maintenance requests and all of these things if you just have a fully Wi-Fi equipped building something we take for absolute granted in a conventional property but that doesn't normally pencil on affordable property so it seems so basic but it is I'm rarely in a conversation where it doesn't come up now and I know that in terms of of the health and housing fund that's one of the areas that we've highlighted and that was even before the pandemic but I think even now even more so which is such a such a necessity and very interconnected to help Andy I'm curious and then let's turn to the chat question I'm curious in the work in the paper success paper success project that you're involved in what impacts of COVID are you seeing there so two things I would say one on a macro level I'm going to steal Kimberly's phrase of doing more with less governments across the country are being faced with that crisis for us that's a really good value proposition because what we're doing is helping government better align the dollars that they do have so in a moment when there is less funding it becomes even more important to align spending with outcomes as I always say to my teenage son he needs to work smarter not harder and that's sort of what we're trying to say to governments is your funding things and you don't know what you're getting what you need to do is fund in a way that aligns those two things so that is sort of our macro picture and what we are seeing after sort of an initial quiet period is really renewed interest on the part of partners in government to really engage with us so that's really exciting to be part of delivering services in those communities on a more micro level when I talked about our project in Memphis around pre-k as we were heading into year two that was going to be largely remote or hybrid in a more typical cost reimbursement structure the money would have just flowed to the organizations they everybody would have in good faith done the best they could within the context of outcomes financing we spent this summer with the providers, the local civic organization that is the lead partner the school district folks from the county having really robust conversations about what does success look like in COVID what are the things we need to deliver to the families and the kids that can help us hold ourselves accountable to success those conversations I truly believe have led to much more robust offerings for those low income in a context when most folks are just muddling through and so by definition this construct of paying for outcomes means that everybody has to have a shared definition of success so for example in year one we were focused on attendance how do you define attendance when school is virtual is it logging in for a minute is that enough can you hold a four year old accountable for that one of the things it led us to was a much broader definition of engagement that wasn't just the child we were talking about when we talked to the folks on the ground in Memphis what they would say is that that is something that should always be true not just for COVID so in that sense these conversations are really changing the field I think much the same way that I think Andrea and Kimberly are seeing in the world before that's really interesting and with the focus on outcomes of success look like and how in the chat Evan did I cut out can you hear me okay oh good good so Evan asked in the chat have you been able to get the economics to work to fund the services long term has it been the county or local hospitals that have committed to this permanent financing for the health side Andrea or Kimberly anything you would want to share around the longer term financing no we touched a little bit on ideas there but any examples you'd want to highlight or point to yeah I would say that there have been some partnerships with some you know hospitals with providers that have shared in some of the funding stream really we're seeing that that comes from a public resource so that is you know that's coming from you know there may be what is called sometimes a consolidated NOFA or application where a city or state may bundle funding so they will bundle their capital funding their operating subsidy to help subsidize the units from the residence rent and then human services so they bundle that so that the developer would have access to that for its project so instead of sort of piecemealing it together you could go one stop shopping for all of your funding and that's been a very successful program that states like Seattle, Connecticut DC does that, New York does that so that's pretty much a public resource we do have a partner VOA Delaware Valley has had some success with projects in New Jersey where they've had some I think one of the hospitals pay in so you do see partnerships and they tend to be service specific rather than funding for whatever the residence need at the moment we think a lot about looking to who actually lives there and what do they need and not what do they need one time but what do they need over the fullness of time so it might change and that's the challenge you may find a community hospital that's in it for the long haul and willing to be there doing checkups measures that may not be the most valuable thing for those residents so the challenge has been what is that source to have that function there to evaluate those needs and connect people to the services and find those partners there is growing appreciation for the value of that and we're starting to see some equity investors ask that question and think about how they construct their investment to at least supplement that piece our partnership with Fannie Mae and their Healthy Housing Rewards Enhanced Services Program actually offers an interest rate discount that provides a chunk of that money for that service coordination function over time. We start talking about traditional healthcare actors and a lot of other folks that depend on contractual relationships or government funding you have a horizon problem with housing. Housers think in 15 to 30 year horizons and if you're talking about MCO contracts you're talking about 3-5 years if you're lucky so those tend to be a little shorter burn and finding that investment that is in funding that coordination function is what's been really valuable and thankfully we're starting to drag towards that. Yeah, really great points and I think from my perspective when I think about services or partnerships with housing often times it's grant based funding which certainly is not a long-term solution so it's interesting to hear some of those other examples Kelly asked once housing needs are met in a community what do you think is next especially for the aging population I think Kimberly you touched on this a little bit earlier accessible and inclusive social and recreational leisure opportunities perhaps kind of getting to your social isolation point anything else you want to add on that topic? In terms of once a senior is appropriately housed what's next? So I think one of the things that we do is I talked a little bit earlier about our VP of housing and healthcare initiatives and looking at where we are so you know we know that people are we're going to be serving a neighborhood where a certain population is going to live so what are the access and needs in that neighborhood and so if we focus on that and you know decide that okay here are some of the sort of the gaps that we're seeing and the needs based on the community needs assessment it's very interesting to look at those and the neighborhoods that we are starting new projects in if we can structure our service component around that and I'm talking about beyond our resident coordinator so this is about thinking about where we may have designated space which is what we're doing and I think we've got seven projects and the UHC health and housing fund and in each of those projects we are refitting the community space so we have designated space for a healthcare provider to come in and do some it's not large space but to do some drop in visits and preventive care if we can identify what those sort of things are so what those needs are for a specific population that we believe will live in that community then I think that that helps always in addition to the social elements that we're programming that we're able to bring and I don't think that they're sort of run down a path I think we provide that all of those sort of benefits and assets together that we have well we have just a couple minutes left I'm wondering if we might want to go around quickly and are there any key lessons learned from your experience developing cross sector partnerships what have they been what should our audience know Andy why don't we start with you oh did I put you on the spot I guess I would say that okay I think the foundation of any strong partnership is what I would describe as a value add partnership where each partner has sort of a set of assets and skills that they are bringing to the effort and that where then what is it the hole is greater than the sum of the parts and what we find when we're working in communities is that we are bringing financial capital and technical expertise but what we know that we need are community leaders who understand that particular community they understand in a deeper way than we do as by way of example what it means to have high quality pre-K and so what we find is if you can be aware of what your assets and strengths are and then rely on others that is really when you come to the best outcome maybe that's stating the obvious well said Andrea Kimberly anything you want to share along those lines you know I think one of the things we're increasingly hearing and learning is the good partnerships cross-extral partnerships can't be transactional you've got to be in it for sort of the greater good in the longer haul and not just trying to get a deal over the finish line I think as a group that has its roots in sort of real estate development and developers that's sometimes a hard moment to get to but if we're talking about moving the needle unwell being for whole communities taking a more holistic look and being willing to be a little mushy around the boundaries of what you're doing and understand what you're trying to make an investment but that it's going to take some flexibility and some creativity to get there and not be as a colleague said so coin operated is an important lesson so I would just add that I think it's really important because it's not you know we housers don't we don't have a long history of working with unless you're in a specific serving a specific population we don't have a long history of working with human service organizations for example or health care you know organizations and so it's not again I spoke to this earlier it's not sort of one of those organic natural partnerships that you just think of right away but I think there is a value proposition that we have for each other and I think it's key to identify that and once you identify that my experience tells me that you always need to then identify a champion somebody that can be the person that you know goes to bat for you and really gets it and you know can help move things through because it's such hard work and there's a lot to break down there so it's going to take a lot it won't happen overnight but I think there's a lot of possibilities you know we've been you know making and inching our way towards progress and moving the needle but I think that as we do more of that you know we're going to have to identify more champions and make sure that you know we're able to center ourselves around the common is as Andy said the common good so we can't do it all on the housing side can't do it all in the health care side it only works when we're working together yeah really well said I think one of the things that comes to mind for me is it takes time and I think that goes to what what everyone said it's you know when you're building relationships and when you're trying to understand different types of programming and different types of organizations it just takes time to understand and that taking the time to understand I think is what can help build a strong strong relationship and also whether you know of course there's going to be challenges and hope to navigate through challenging times as well you know we're we're over time thank you so much everyone for joining us and Kimberly Andrea Andy thank you so much for sharing your experience with us really appreciate it and thank you it's been a pleasure thank you thank you it's been great