How I think about this work
Two ideas run through everything Updraft Advisory does. They operate at different scales — one is about organizations, one is about the people those organizations serve — but they're expressions of the same instinct.
The organizations that serve people most effectively share a common trait: they don't operate in pieces.
Programs lean on each other — for expertise, for internal referrals, for the accumulated knowledge that only comes from working alongside colleagues who understand the same population from a different angle. Finance isn't a back-office function; it's a real-time window into whether the mission is sustainable. Staff bring whole lives to work, and organizations that treat them as inputs rather than people produce predictable results. Marketing, facilities, technology, program operations — in a well-run organization, these aren't separate departments managing separate concerns. They're expressions of the same mission, and they work best when they're integrated around it.
This is the lens I bring to every engagement. Whether the work is a program launch, a merger, a policy fight, or an operational turnaround — the question I'm always asking is: where are the seams, and what's falling through them? The answer almost always points toward something structural: a disconnect between finance and program, a culture that rewards silos, a data system that nobody trusts, a leadership team that has stopped talking honestly about risk.
The consulting work is about finding those seams and doing something about them — not through a framework imported from somewhere else, but through the kind of operational judgment that only comes from having been accountable for the outcome.
The same principle applies to the people these organizations serve.
The PACE model gets this right. An interdisciplinary team, integrated funding, coordinated medical and behavioral and social supports — all wrapped around someone whose needs are too complex for any single program to manage alone. It was designed for elders who would otherwise require nursing home care. It has worked, consistently, for decades.
The adults who fall below that threshold — younger people with complex intellectual and developmental disabilities, co-occurring behavioral health diagnoses, significant medical needs — are being served, when they're served at all, through a patchwork of programs that weren't designed to talk to each other. IDD day services. Outpatient behavioral health. Neurology. GI. Pulmonology. Primary care. Each doing its part, none of them coordinating in the way that actually changes outcomes.
The clinical complexity is real: seizure disorders, swallowing and aspiration risk, behavioral presentations that are misread as psychiatric when they're neurological, significant cognitive delays, muscle tone and mobility issues that interact with everything else. These are not simple cases. They are exactly the cases that an interdisciplinary, integrated model was built for.
I believe the PACE model — adapted thoughtfully for this population — is what that coordination could look like. I'm working toward that: through coalition relationships, through conversations with the people already doing this work in pockets, and through a consulting practice that keeps me connected to the organizations and systems where this model would eventually have to live.
If you're thinking about this too, I'd welcome the conversation.
Sector context
Developing the case for PACE expansion to younger adults requires relationships in the right places — with operators, advocates, state agency staff, and the coalitions where these conversations are beginning to take shape.
PACE operations
Direct operational experience at Element Care (de novo launch, no-deficiency CMS review) and PACE Vermont (corrective action, managed closure). Active connections to Massachusetts PACE leadership.
IDD sector depth
Thirty years serving adults with intellectual and developmental disabilities — day services, residential, employment, family support, Pre-ETS, and transition services. Deep familiarity with DDS, EOHHS, and the provider community.
Behavioral health proximity
Clinical literacy through RBTR Institute and substantive proximity to BCBA practice. Understanding of how behavioral health intersects with IDD in complex presentations.
Coalition experience
ADDP Day Services Committee co-chair. Arc of Massachusetts Council of Executives. The advocacy experience that produced the 75th percentile rate shift is directly applicable to building a policy case for PACE expansion.