A ‘holistic, scalable and sustainable’ investment strategy for Baltimore | GUEST COMMENTARY

Baltimore City’s needs are undeniable. The city is beset by poverty, drug addiction and crime, all of which lead to poor school performance, unhealthy residents and barriers to investment in the city.

And yet, now more than ever, there are enough dollars flowing into Baltimore to serve many of the major needs of Baltimoreans (particularly with the recently passed Biden administration’s American Rescue Plan).

What is now necessary is for us to come together around an investment strategy for the city that is holistic, scalable and sustainable. In public health, we use a simple construct to guide our efforts: needs assessment, policy development and assurance.

Needs Assessment

The first step for this effort is to ascertain the myriad needs (and their costs) of city residents. One way to identify these necessities is to use the model of the four-legged stool of a successful city. In order to be a thriving municipality a city would need:

1. Affordable health care and access to healthy food;

2. Affordable and safe (from vermin, lead and violence) housing;

3. Strong public schools;

4. Accessible and available living wage jobs for adults in their communities;

From this paradigm, we could get a good estimate of the costs of the effort.

Policy Development

Baltimore’s nonprofits are notoriously fragmented, which leads to significant duplication of services. There needs to be a far more collaborative effort by these well-intentioned organizations. To develop the focused policies that are necessary for this effort, Baltimore’s numerous nonprofit organizations need to do a much better job of partnering with their fellows, as well as with the city government.

Foundations and religious and academic institutions are vital to the city, serving as social service groups and health care providers, as well as major employers and economic engines. Thus, they are essential partners in this initiative, and must work collaboratively as well.

While all the above efforts will allow for programs to be taken to scale, they still must be sustainable. The most effective way to do this is through a reinvestment construct, called an Opportunity Compact (developed by Baltimore’s nonprofit Safe and Sound campaign, which dissolved in 2018). Opportunity Compacts are a type of public-private partnership that finance evidence-based approaches to costly social programs. Each compact uses a one-time investment to get the intervention going. If the program is successful, the compact allots savings to continue to grow the program, and then splits any additional savings between the government and new investments to support evidence-based projects to improve outcomes for at-risk populations.

Compacts have been used in Maryland for two decades, in areas as diverse as substance use treatment, foster care, jobs, mental health and juvenile justice. These compact-funded programs have saved millions of public dollars, which have been reinvested in these successful efforts. A similar approach of encouraging startup funding and reinvesting the savings can be used in this effort.

Assurance

To help lead this endeavor, a newly formed public-private investment team would serve as both a “bank” to provide seed money to promising evidence-based programs, as well as the coordinator of efforts at the highest level of government agencies to insure fidelity to the design of the specific program.

This very important oversight group should represent the diversity of Baltimore’s residents, while assuring that no favoritism is shown. Its job is generally not to manage the funding going to the many programs supported by a variety of sources of dollars — it is to be sure that nonprofits concentrate their efforts appropriately, foundations fund programs in a focused way, and that the city uses hard-won state and federal funds well. (This includes tracking the use of the new federal dollars, from the two large stimulus bills, while keeping in mind that many of the programs funded with these dollars will need to be sustained with compacts, since the stimulus bills are time limited and won’t be fully implemented.) It also will identify gaps in the system and work to ensure that these are addressed.

Baltimore has many obstacles to overcome to become a more equitable community. It will require a much more coordinated and long-term funding strategy to achieve that goal. Yet the strength and resilience of its residents provide a foundation on which to build. Now is the time for this effort.

Dr. Peter Beilenson (plbeilenson@gmail.com) is the former CEO of Evergreen Health and a former Baltimore City Health Commissioner.