May 6, 2019

From Promising Model to Major Investment

Nancy Roob & Mark Edwards

The head of Blue Meridian Partners and the cofounder of Upstream USA discuss their partnership in using a big bet to transform women’s healthcare nationwide.

This article is from Bridgespan's supplement on big bets for the Spring 2019 issue of Stanford Social Innovation Review. Click here to download a PDF of the full supplement.

By: Nancy Roob, Mark Edwards

Low-income women are five times more likely to have an unplanned pregnancy than women of higher incomes. The systemic barriers at places where low-income women receive their healthcare can prevent them from single-visit access to the birth control method of their choice—an equity issue which can lead to higher rates of unplanned pregnancy and result in a broad set of negative health, economic, and social outcomes for women, children, and families.

To address this problem, Blue Meridian Partners in 2017 committed $60 million over seven-and-a-half years to support the ambitious scaling plan of Upstream USA, which provides training and technical assistance to health centers so they can offer patients in a single visit the full range of contraceptive methods, including long-acting reversible contraception. In working to transform how health centers provide family planning services, Upstream is trying to help women achieve their own goals, reduce the nearly three million unplanned pregnancies that occur annually in the United States, and address an issue that research points to as a significant contributor to poverty.

Upstream was founded in 2014 and had a budget of roughly $10 million before Blue Meridian’s investment. So how did such a young organization secure $60 million from Blue Meridian to support the first chapter of its national scaling plan? Both of us, one a philanthropic investor (Nancy) and the other a social sector leader (Mark), see five considerations as especially important in making the investment:

The potential to help solve a significant problem: Blue Meridian found Upstream’s potential at scale especially compelling. A promising and growing body of evidence demonstrated that expanding contraceptive access could significantly decrease rates of unintended pregnancy—a problem that may not be all that visible, but which changes the course of lives for so many families in this country. While Upstream was still a relatively new organization in 2017, it was already working at scale and demonstrating some important early results that its intervention could work across the entire healthcare infrastructure in the state of Delaware. For Upstream’s team, Blue Meridian’s investment invited them to imagine tackling this problem in way that could actually expand opportunity for millions at scale.

An economic model that made sense at scale—with philanthropy playing a catalytic role: Blue Meridian was also drawn to Upstream’s model, which could readily be repeated across the country. Upstream would go into a state, create a more effective healthcare system with access to best-in-class contraceptive care, tap existing public and private insurance payers to fund such care in the future, and then move on to the next state. Upstream’s model involved improving existing healthcare infrastructure rather than creating a new one. This approach offered a path for investors like Blue Meridian to use philanthropy to generate lasting impact.

Leadership: When making a big investment in an organization, investors want to have confidence in its leadership. Upstream is unusual in having co-CEOs—a unique situation that Blue Meridian had not encountered before. In time, Blue Meridian came to appreciate the organization’s highly entrepreneurial and visionary leadership whose talents and split responsibilities complemented each other. They also demonstrated an emerging track record of being able to execute and get things done.

Commitment to evaluation and to a culture of continuous learning: Upstream, as encouraging and compelling as its early results were, sees ongoing learning and improvement as core to its mission. Unrestricted, performance-based capital from Blue Meridian allows Upstream’s team to realize this commitment and build capacity to measure and assess the organization’s work in real-time, as well as to pursue and commission rigorous independent evaluations.

A strong scaling plan: Blue Meridian provides its potential grantees time and funding to develop a strong scaling plan, with support from its team of senior managers and an outside consultant (most often The Bridgespan Group). It is a mistake to think of organizations as being simply ready or not ready for immediate national scaling, as if it is an either-or question.

Upstream and its co-leaders had a compelling vision and early plan, though it needed a lot of development. With Blue Meridian’s support, Upstream had the chance to work with its own team and some outside support, to ask itself a lot of hard questions, and to build upon its vision to craft the first chapter of its national scaling plan—seven-and-a-half years, four states, and more than one million women reached. It came out of the process with a detailed road map specifying the strategies and capacities necessary for reaching its ambitious goals—in a way that made it compelling to Blue Meridian’s investors.

Now that the $60 million investment has been made, the scaling plan and its intermediate milestones remain the focus for Blue Meridian’s and Upstream’s continuing work together. The major investment has also served a catalyst for follow-on investment. Our hope is that this trend continues, and additional funds will be committed to support Upstream’s expansion in targeted states.

In Upstream, Blue Meridian found an organization and leaders who had vision, who could take ownership of their destiny by building a plan, and who were prepared to hold themselves accountable to performance. And now Upstream finds itself on a new trajectory—committed to an ambitious scaling plan supported by flexible and upfront growth capital. Thanks to Blue Meridian’s support, Upstream is able to talk to other funders with much greater credibility and confidence, and to continue working hard to build the infrastructure that will enable it to deliver on its vision and its plan.

Nancy Roob is CEO of Blue Meridian Partners.

Mark Edwards is cofounder and co-CEO of Upstream USA.

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