Month: June 2021

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The 3-point revolution in basketball: a lesson for grant seekers and grant writers

I’m old enough to remember the time (not that long ago) when the most important player on most basketball teams was the low-post man, often a back-to-basket center, like George Mikan (the original), Kareem, Wilt, Shaq, etc. That was upended a few years ago with the 3-point shot revolution pioneered by the Golden State Warriors (think Seth Curry, Klay Thompson, etc.). The 3-point shot was added in 1979, but it took basketball experts almost 40 years to figure out that it’s more efficient for players to take more 3-point shots than 2-point shots, even if the shooting percentage for 3-pointers is lower. Maybe humans are less rational than the classical model suggests, if it took so long for teams to optimize for a change, even in a relatively small, controlled environment like pro basketball.

Greater efficiency is achieved by 3-point shooting even if fewer balls technically go through the hoop: we can apply a similar idea or set of ideas to grant writing. It’s more efficient for a nonprofit to submit more proposals rather than spending too much time and resources polishing a smaller number of proposals. We’ve been through many client-induced “polishing” and extensive “editing” exercises with proposals, and they typically generate diminishing returns. Imagine the Lakers rebounding at the Jazz basket and having to take a shot at their end within the 24 second shot clock: the point guard could spend 22 seconds working the ball into a low-post player, who (hopefully) takes a high percentage shot, or the point guard could quickly dribble to the 3-point line, hand off to the shooting guard who takes a 3-point shot at the 6 second mark. While the completion percentage is much lower, this results in many more possessions and opportunities to shoot and score.

In grant seeking, a nonprofit could have its grant writer work tirelessly to polish one grant proposal or have the grant writer do a credible, but maybe not perfect, job on three proposals during the same “grant writing shot clock.” The second approach is likely to produce more funded grants than the first approach, largely because you’re taking more shots on goal. As hockey GOAT Wayne Gretzky famously put it, “I missed 100% of the shots I didn’t take.” Moreover, there’s a lot of noise in the grant evaluation process, just as there is in dating, jobs, and many other human endeavors. The people who succeed most in dating or jobs typically try a lot of different things, knowing that many possible romantic prospects will not like them, for whatever internal reason, and the same is true of employers.

In grant writing terms, and as we periodically blog about, “many shots” means avoiding the perils of perfectionism. It doesn’t matter how perfect the proposal is if you miss the deadline. Also, it’s best to understand that grant reviewers will not study your proposal like the Talmud. At most, the reviewers, who are likely reading dozens of proposals, might spend a half hour reviewing your 40-page opus. As long as the proposal is technically correct and tells a compelling story, it’s probably good enough, since funding decisions go well beyond the proposal itself, including such unknowable considerations as location (urban vs. rural), target population, ethnicity, number of similar applicants, and, the old standby, politics.* There’s likely a pin map in the Under Assistant Secretary’s office to figure out which high scoring proposals will actually be funded (too many in red state Texas, then let’s move a couple to purple state Arizona in anticipation of the 2022 midterms).

Like NBA players who practice long hours to improve their 3-point shooting, your grant writer should be able to get better and faster at writing proposals. Writing proposals, though, is a job that’s hard and drives many grant writers or prospective grant writers mad, or encourages them to leave the business—which is why we have the business we do.

  • At least with federal programs, and large state programs, this is almost never any RFPs of the “let me give you $10,000 in unmarked bills, or bitcoin” variety, but rather of the “Texas is getting five grants, and California zero? That needs to be better balanced” variety.
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The latest Service Area Competitions (SAC) from HRSA are here, and the FQHC Shuffle

2020 was a peculiar year for many reasons great and small, one of the small reasons germane to grant writers and Federally Qualified Health Centers (FQHCs) being that HRSA deferred Service Area Competitions (SAC), allowing FQHCs to skip the typical application, or re-application, process. For those of you unfamiliar with FQHCs, they’re the nonprofit healthcare providers that are designed to accept any patient, regardless of ability to pay, and that specialize in Medicaid patients, or helping the uninsured sign up for Medicaid. FQHCs and their counterparts, FQHC Look-Alikes, have significant advantages over typical nonprofit or for-profit primary healthcare providers in that they get higher reimbursement rates from Medicaid, protection from medical malpractice lawsuits, access to the 340B low-cost medication program, and a few other advantages—including eligibility for Section 330 grants via the SAC process, which offer between hundreds of thousands and millions of dollars per year in funding. Every (or almost every) geographical area in the country is supposed to be covered by a SAC and most FQHCs must submit a competitive SAC proposal every three years to keep their Section 330 grants.

Delaying SACs seemed like a reasonable idea during the pandemic, and their return is likely to herald some changes. We talk to lots of FQHCs, and it seems that some of the incumbents are weaker than they were, or discombobulated by the pandemic. Others, however, seem to have been strengthened, particularly those that moved expeditiously to telemedicine, which let them keep up their patient loads, while others have struggled with telemedicine. It’s often not apparent from the outside what’s happening on the inside of FQHCs. Some that may seem weak are likely strong, and vice-versa. That’ll make this SAC season unusual and interesting, and I’d not be surprised to see larger-than-average turnover in SAC grants. Because each SAC covers a specific geography, any new applicant is by definition trying to take over the designation from an existing grantee. We’ve heard the SAC process called “the FQHC shuffle.” Most FQHCs succeed in getting their SAC proposals approved and Section 330 grants renewed, but a significant portion don’t; most of us wouldn’t want to play a game we don’t think we’ll win.

We’ve worked with FQHCs on both sides of the SAC shuffle: incumbents worried about upstarts, and upstarts interested in taking over the incumbents’s service area and Section 330 grants. Losing a Section 330 grant can be an FQHC’s death knell: while SACs typically compose less than 20% of an FQHC’s budget, and often less than 10%, they often function as the glue holding the organization above the water level. Lose the SAC, and the overall revenue decline may be small, but that revenue may also be the revenue that keeps the organization in the black. During uncertain times like the present, an alert organization may be able to make progress that would be more difficult in other times.

Three of the eight planned FY ’22 SAC NOFOs have been issued so far: you can see whether your organization’s service area is up for renewal in HRSA’s massive SAC lookup table. The rest will be issued in the coming weeks or months. Is your FQHC or would-be FQHC ready to act?

Although the pandemic is receding, we’re still living in a strange time: the nonprofit winners have a lot of cash; some nonprofits, however, are gone. The next generation of nonprofit startups haven’t wholly started up yet. This is a propitious time to pursue change. We’ve been talking to a lot of callers about what’s happening in the present and what the future might hold.