“What business are you really in?”
Economist Theodore Levitt established this question as a central consideration for any enterprise in his classic article “Marketing Myopia.” It sounds like such a simple question, but it can be very difficult to answer, and answering it well can mean the difference between thriving and dying.
As Levitt pointed out in his article, the railroads—once dominant forces in the US economy—fell into decades of decline because “they assumed themselves to be in the railroad business rather than in the transportation business. The reason they defined their industry incorrectly was that they were railroad-oriented instead of transportation-oriented; they were product-oriented instead of customer-oriented.” In other words, focusing on their existing mode of operation gave them myopia about their business and market. They neglected opportunities to develop strongholds in trucking, telecommunications (they owned rights of way for wirelines), and other areas.
The Internet—search and mobile apps via laptops, smartphones, and tablets—has posed a severe challenge to many industries over the past 10-15 years, particularly to businesses that depended on their position as distributors of media, such as record labels or newspapers. Increasingly, the disruption is shaking up high-value personal services (such as law, accounting, and even medicine) that apply judgment and knowledge to a custom set of facts.
In nonprofit health and human services delivery, the market has protected providers from competition; after all, they serve customers who have little ability to pay. But as technology becomes more powerful and affordable, applications such as remote health monitoring, telemedicine, artificial intelligence and—inevitably, it seems—robotics will pose similar challenges to existing health and human services providers and systems, even as they propose to improve lives on a vast scale.
Nonprofits that seek to improve lives by coordinating services that meet multiple needs—through wrap-around services supporting schoolchildren or people at risk of homelessness, “no wrong door” benefits initiatives, and other means—likewise face a future that is both exciting and daunting. For broad swaths of the social sector, the challenge will be not only how to coordinate services for people who seek them, but how to identify and push services to those who may benefit from them—similar to the way Google and Amazon push ads, or the way retailers identify and target information to customers going through life changes such as pregnancy. The question of what business you are really in is particularly urgent, however, for information and referral programs seeking to connect people to health and human services—such as area agencies on the aging; independent living councils; warm lines for housing, mental health, and substance abuse; even crisis centers. To illustrate those challenges, let’s examine 2-1-1 information and referral services.
The 2-1-1 services use the three-digit dialing code 2-1-1, an easy-to-remember telephone number, to connect people to essential community information and services, 24 hours a day, seven days a week, in multiple languages. Ninety percent of US residents have access to 2-1-1, and low- and moderate- income people particularly rely on it. There are an estimated 246 independent 2-1-1 providers in the United States, responding to 16 million callers and perhaps three to four times as many web queries annually. An important feature of 2-1-1 is that users can reach a live, trained specialist. That is incredibly valuable, given how difficult it can be to reach a live person when dealing with credit card companies, banks, or other businesses—so much so that some financial services companies seek to stand out by advertising access to a live person as a special feature. It is not just a matter of good customer service; it produces better results for clients. Most people seeking services have needs in more than one area. For example, if a caller needs food because he lost his job, a specialist will not only make a referral to a food pantry, but also typically ask whether the caller is interested in and eligible for SNAP food assistance, whether he has health coverage, and whether he has children who may be eligible for health coverage and other resources. Access to a live trained specialist should never go away; it is very important, especially for people in crisis, and when communities face disasters and emergencies.
But culture is changing perhaps even faster than technology, and 2-1-1 is ill-prepared to adapt to the rapid pace of both technological and cultural change. People around the world have radically changed their expectations and “information-seeking behaviors” (just ask a librarian). In Asia and Latin America, people of all income levels, including the very poor, use cell phones to handle financial transactions and access the web. In the United States, despite a persistent digital divide in broadband access, even low-income users and English-language learners increasingly query the web as the first step in seeking information—Spanish-speaking Latinos in California, for example, are among the highest users of smartphones. At best, placing a voice call may be a person’s third or fourth option, after a web search, a question to their social media networks (through Facebook, Twitter, Google+), or text messages to close friends and family.
Indeed, the notion of “search” itself is changing; rather than people searching for information, information is finding people—it’s tailored to their needs and pushed to them. Market makers tell us that people increasingly want information services that anticipate their needs, despite the creepiness that comes with unwanted pitches from advertisers, or the prying eyes of insurance companies or financial institutions. (I’ve argued before that nonprofits need to confront their own squeamishness about analyzing and using data to push resources to people in need.) Think of the “Internet of Things” and the future of wearable tech as examples; what will your refrigerator tell sellers about your eating and drinking habits, or what will your Fitbit tell your doctor and insurance companies about your needs?
Unfortunately, most 2-1-1 providers still think they are in the “responding-to-people-who-call-us” business. For too long, 2-1-1 has relied on the phone as the channel, on one-on-one communication as the medium, on proprietary databases about publicly-available services, and on the government-regulated license to use the three-digit dialing code as its competitive advantages. These attributes are important strengths, akin to very valuable real estate, but they are washing away. Google and other search engines and apps are serving up data on health, human services, and education resources that soon may be just as valuable as carefully curated 2-1-1 datasets (they still really aren’t there yet), and the pull and push capabilities of commercial and government applications (see Open 311 or other Code for America projects) are washing away the value of 2-1-1 real estate. On top of that, the shift to mobile telephony is undercutting the entire state-based regulatory framework surrounding the use of the three-digit dialing code. These technology shifts, in combination with changes in users’ information-seeking behavior, are forming a feedback loop of heightened expectations that threaten to greatly shrink the relevance of the live personal assistance at the core of 2-1-1’s current business model.
The world now demands push rather than pull, interoperability through APIs or other means, and an open-source approach to the resource and client data (anonymized) that 2-1-1s have.
The challenge then is for 2-1-1 programs to get out of the call-center business and move to making their resource data and their data about users’ needs usable by the whole wide world. Call centers and community-specific data demand a great deal of energy and resources to maintain. With many of the 246 nonprofit 2-1-1 programs across the country, undercapitalized and overburdened, there is little slack available to experiment with new approaches and invest in promising paths. Unfortunately, the largest and best-resourced 2-1-1 providers have the most invested in people and infrastructure for responding to callers, and may have the greatest difficulty moving to the new future. If they lean into these changes, 2-1-1s can survive and thrive, but it’s unclear how providers can raise the capital they need to move to the new model or how they can build a revenue model that will sustain them.
So what’s the business of 2-1-1? Just as trains are to transportation, voice calls and call centers are to 2-1-1 information and referral services. Thinking more broadly, the business of 2-1-1 is to organize information about people’s needs and the resources available to meet those needs; deliver that information to people in a way that’s relevant to their needs; and inform funders, policymakers, community leaders, and other stakeholders about what people need to support system change.
The good news is that providers can accomplish a lot of this by letting others do the work—by pushing information to end users, or using APIs to put it at the fingertips of doctors, nurses, and teachers, in their own systems. By opening up in this way, 2-1-1 can greatly expand its impact and potentially develop new revenue streams. Ironically, appearing to turn away from live voice service and from well-trained specialists may be the only way to save a very powerful but undervalued service.
The core mode of delivery for many social sector organizations—particularly health and human services for low-income people—has so far been somewhat insulated from technology disruption, but the generational shift in consumer expectations and information-seeking behavior (paired with the increasing power and affordability of data mining and sharing) is upon us and demanding a response. Services such as 2-1-1 must fundamentally change how they operate if they want to avoid obsolescence, and the well being of millions of vulnerable people around the world depends on it.