ReNEWing the Future of Nursing Through Outcomes-Based Financing

Wesley Smith (03:26.862)
Bob, Debbie, Justin, welcome to the President’s Forum Podcast.

Debbie Mazur (03:52.679)
Great to be here.

Justin Bakule (Social Finance) (03:53.052)
Thank you.

Bob Collins (03:54.049)
Thanks.

Wesley Smith (03:54.797)
Hey, before we get into this finance innovation conversation, can we just do a brief round of self-introductions so our listeners have some context on you know who’s who’s talking and the expertise that you all have in in this conversation? Bob, can you kick us off?

Bob Collins (04:11.469)
Great, sure. Will thanks. greetings. My name is Bob Collins. I’m a senior advisor and the vice president of talent finance at Western Governors University in the Office of the President. I’ve been very fortunate to have spent my entire career as a financial aid administrator. And you know, the the work that I’ve completing here for the Office of the President is from a senior advisor role. It’s more of a federal public policy kind of work influencing legislation and regulation.

And on the VP of talent finance, that’s the innovative financing that that is my focus right now. So that’s a great opportunity. Yeah.

Wesley Smith (04:47.768)
Great. Bob, I can I can tell our listeners too that you’re you’re probably my go-to expert on higher ed finance generally. I I I go to Bob because I know how much experience you have, Bob. Thanks for joining us. Debbie, Debbie, can you can you tell our listeners a little bit about you, your background?

Bob Collins (05:02.221)
Thank you.

Debbie Mazur (05:08.571)
Yes, absolutely. Hi everyone, I’m Debbie Mazer and I am the head of the Healthcare Vertical Workforce Partnerships here at Western Governors University. My background has been in workforce development, higher education, and healthcare for my entire career. So I’ve had the pleasure of working alongside many of the largest hospitals in the country to help them to solve for their workforce challenges.

Wesley Smith (05:32.44)
Great. Thanks for joining us, Debbie. And then Justin, we’re coming your way now.

Justin Bakule (Social Finance) (05:36.957)
Sure. My name’s Justin Backley. I’m a vice president of of impact investing at social finance. We’re a national nonprofit that focuses on a lot of things. But in this context, we run 12 different workforce investment funds, all aimed at serving underserved learners with innovative student financing models to get them into better jobs.

Wesley Smith (05:59.361)
I I love the breadth of knowledge there. So you you don’t have just this one program that that you can draw from from experience. You you have a dozen or so that you can say, Hey, this is what we’re doing across the board.

Justin Bakule (Social Finance) (06:12.69)
That’s right, Wes. We we run 12 different funds with about a little over $300 million at play in the marketplace, either deployed or ready to be deployed to students. And at this juncture, we’ve served over 17,000 students across the United States. So that’s right. We’ve worked across a number of different contexts, of which though the the partnership here with the renew fund and WGU is is one of the most exciting ones that we have.

Wesley Smith (06:36.866)
Yeah, fantastic. Thanks for joining us today. let’s get started. Big picture, Bob. tell us a little bit about the changing, you know, student finance landscape. This has been boiling for a long time. And there have been, you know, we’ve needed to address financial aid generally and just the way that we finance higher education in in the United States. So tell us a little bit about specifically the growing interest in outcomes-based financing.

Bob Collins (07:05.271)
Yeah, absolutely. Thanks. yeah, we’re in a new era of borrowing, right? or how to pay for college, circa twenty twenty six, right? But before we go there, let me let me give you a a brief history of of higher education and finance. you know, most of us recall the higher education act of nineteen sixty-five as the legislation that really got us to where we are, but it actually started before then. It was in nineteen forty-four.

When they created the GI Bill. That was for veterans. It allows housing opportunities, mortgages, as well as paying for education after World War II. So it’s tuition and fees and some living expenses for the veterans. It was a great program then, and it’s still a great program today. Fast forward just a couple of years later to 1958, it was the national defense student loan. That was the first type of loan.

Implemented by it’s federal funded, but it was school as the lender in that space. And this was 1958. This is the Soviet Union, Sputnik, right? Science, engineering, math, you know, the technical skills. We needed to compete. So that’s how we got to 1965. These two programs were very successful, and so they expanded them in HEA’s 19 Higher Education Act 1965 to include the basic educational opportunity grant.

Right. So that’s known as the Pell Grant today. So there was some grant funding for low to moderate income individuals, as well as a student loan program. It was either federally insured or federally guaranteed. That loan program was bank originated. The banks would originate the loans, service the loans, and then they would be reinsured by the federal government up to 98% if the student should default.

So that’s the 1965 version of this. Let’s fast forward to 20 years ago, 2006. What happened then? Congress passed the Graduate Plus Loan Act, which made graduate parent or graduate loans unlimited, up to the cost of attendance. That was just 20 years ago. And it’s kind of mimicked the parent plus loan where where parents could borrow up to the cost of attendance.

Bob Collins (09:23.587)
for their for their children, for their dependents. And that basically covered all the direct and indirect costs, tuition fees, meals, housing, et cetera. So, you know, 20 years later, we’ve got a student loan debt crisis, right? 1.7 billion trillion, excuse me, that’s with a T, 1.7 trillion in debt and unmanageable debt. It’s just out of control. And so I think what happened

You know, since since that 20 years ago, there was also an economic downturn, if you remember, in 2008 where the where the bank originated loans were eliminated. And it became an exclusively a federal direct student loan. So the federal government is now the lender in these programs carrying that $1.7 trillion in student loan debt. So it’s it’s kind of a a situation now where what was introduced more recently was the work.

working class, what was it? The

Bob Collins (10:25.047)
Working Families Tax Cut Act. That was just introduced effective this July one. So it’s also known as the one big beautiful bill, right? That that was effective July one. And it basically it limited the amount of the grad plus loans. Actually, it it eliminated grad plus up to cost of attendance. And it also put some restrictions on the Pell or the Parent Plus loan. And so that that was the that was the working, that was the recent legislation that put those constraints in place.

You know, and candidly, without meaningful limits on these student loans, it turned into unmanageable debt. So it’s really a good piece of legislation that in that regard. But more recently, there was some legislation that passed where with these new federal borrowing limits and the and the changing financing landscape, institutions we need to adapt. And so now we need to look at student-centered financing, and that would be the urgency.

Would be expressed by the reflected in the bipartisan outcomes-based financing bill that both the House and the Senate introduced this summer. And so that was House Bill 9469, June 25 that was introduced this year, and then Senate Bill 4943, June 24. So back to back, bipartisan, bicameral legislation.

Justin Bakule (Social Finance) (11:35.174)
Yeah.

Wesley Smith (11:48.792)
So Bob, tell us about just tell listeners w about outcomes based financing. What does that mean?

Bob Collins (11:54.646)
Actually, my colleague Justin Backley can probably describe that the best. Justin, you wanna put that?

Wesley Smith (11:59.555)
Okay.

Justin Bakule (Social Finance) (12:01.038)
Yeah, sure. I mean, Wes, I guess let’s start with the learners, right? So, what’s the worst outcome we can imagine for somebody trying to pursue a degree? In this example with Renew, we’re talking about trying to become a nurse. Pre-licensure meaning the person is not working in the nursing field their first degree to get their licensure. The worst outcome is that they’re unsuccessful in getting that degree or a job and they end up with student debt, right? As a student. And in essence, in any educational, traditional educational loan,

You’re asking the person to take out a loan under the premise that they’re going to get a better job at the end to be able to both repay that loan and have a productive life, right? Moving forward. So when you introduce an outcomes-based dimension to it, in the case of renew, what we’re talking about is if you don’t graduate, life gets in the way for whatever reason. In nursing, if you don’t pass the end clicks, or you don’t even get a job making a certain amount of money, those are it is making the debt unserviceable.

Those are all the outcomes we try to prevent or protect against. So that if that happens to a student, they actually don’t have to pay us back. And here, what we’re trying to do is align the incentives of the financing with what we want for the student, which is the best outcome. Get that job at the end of this and a productive job that they can move forward with. So when we offer those protections, you can imagine how different that is from a traditional student loan where

None of those questions are being asked about your outcome. It’s just a debt that you have to repay under any circumstances. So that one point seven trillion dollars Bob mentioned of outstanding student debt, we’re saying, Hey, for the places we can finance students, if the outcome is not achieved, if they don’t get the better job, don’t make them pay us back.

Wesley Smith (13:49.069)
Right, right. Okay. So I want to get into now the specifics of what we came to talk about. That’s the renew basics. Like let’s get into the renew program and let’s let’s let’s get a good overview of what you’re doing. And Bob, I’m coming back to you for that. Tell us a little bit about like big picture. What is the renew program?

Bob Collins (14:07.563)
Yeah, let’s start with the acronym RENU, right? Financial aid, you gotta have an acronym. It’s reinvesting in nursing, education, and workforce. Renew. Okay. So that was the the moniker that we put on it. we met with social finance about three years ago. It’s the problem to solve, the critical nursing shortage, right? So we year one, we spent a kind of like the design phase, if you will, to look at the what how do we increase access, remove financial barriers for students.

And so we partner with social finance to look at and I you know, Justin can speak to the the financing, the the fund itself, but what we’re trying to do as an institution is to remove financial barriers for the pre-licensure nursing program. It’s a really expensive program to deliver, and what we wanted to do is help those low to moderate income individuals re provide that, you know, the access to these programs. If if you take a look at our student demographics in the in the pre-licensure nursing program.

more than half of them are Pell eligible students, which is which is phenomenal. I mean, they go on to a a better paying job w upon completion and getting the BSN, right? So basically we we cover the the last two years of the program. That’s where it’s really gets expensive. You’re gonna have two simulation clin lab work that you’re gonna need to travel to and spend two weeks at these simulation labs. You’re gonna have to do seven clinical rotations. That’s

That’s going to reduce your hours at work and it’s be you know intense where you still need to pay rent and buy food. You know, you need a method of payment to cover those. So the renew fund was established to to not just to supplement the federal student loans, but to supplant. So in other words, we’re we’re funding the last two years of the core nursing program for low to moderate income with this renew fund.

as well as their Pell Grant and other scholarships and gift date. Justin can probably speak to a little bit more about the mechanics of the funding.

Wesley Smith (16:11.074)
Yeah, Justin, give us some mechanics on the funding and then Debbie, I want to hear from you about the employer role.

Justin Bakule (Social Finance) (16:17.19)
Yeah. Let’s let’s Wes, let me s start at the end and and work work backwards. So contextually, when we started Renew, what were we what were we looking for in a marketplace? and by marketplace, I mean a marketplace of jobs and job demand. We wanted to find places where, to be honest with you, what I sometimes refer to as the employer talent desperation curve was at a peak, right? Where are employers?

Wesley Smith (16:23.735)
Okay.

Justin Bakule (Social Finance) (16:46.892)
Most desperate to recruit and retain workers for what underlying business-driven reasons? And because what we’ve learned, and and Debbie can speak more about this as well, when you go talk to employers about talent issues, frankly, every, you know, I always like to say every everybody has a lot of problems. Right. You ask people what their problems are as an employer, they’ll give you a long list of problems. However, there’s a different, shorter list.

That I think employers are willing from a business perspective to pay to solve and invest in. So we were looking for places where the problem on the job demand side versus supply were at at the most severe, right? Because in a world in which we want to link students up to jobs most reliably and ideally then even have an employer willing to repay that financing on behalf of the student.

We need to be in the spaces that have the biggest problems. And healthcare, writ large, was that place. I’ll pause after this, but then the second thing for us that happened to match up very nicely with WGU is when you want to do something like that, for us as a nonprofit, you want to do it at scale. And so you need a high quality educational institution that can scale and that has ambitions for scale.

And I would also emphasize between our two organizations that has a mission orientation that is shared for why they want to scale, who they want to serve in terms of students. And then from there, a lot of the details about how to structure a financial product to align with that student body, PEL-eligible, highly PEL-eligible, with what employers need on the other end.

is a mechanism of a set of design decisions that were undertaken by both organizations in in service of the students we’re trying to support.

Wesley Smith (18:43.598)
It makes sense that, you know, both both of the organizations are dedicated to the student first and foremost, and then and then you know creating opportunities. So everything, all the decisions, you know, downstream of that seem to be a lot easier if you’re aligned on what the outcome should ultimately be, which is a a better, you know, a better outcome for the student.

Justin Bakule (Social Finance) (18:49.189)
Right.

Justin Bakule (Social Finance) (19:05.97)
Correct, correct. And so to Bob’s point about supplanting federal lending, for us, the eligibility criteria for new is Pell eligible students. So again, drawing from a high percent to total, but trying to serve those for which the financial barrier may well get in the way of persistence and success. So starting with that broad Pell eligibility to identify eligible students within WGU’s program. And then for us, the question is how best to serve them with a financial product.

Wesley Smith (19:15.019)
Uh-huh.

Justin Bakule (Social Finance) (19:35.887)
related to the cost of attend total cost of attendance at WGU. And here, under any circumstance, we want to give them the best financing deal they can. In this case, it means a 0% zero fee loan with the outcomes based protections. So if they don’t graduate, don’t pass the NCLEX, or don’t get a job with a $60,000 minimum income threshold, they don’t have to pay us back. Again, making sure that there’s downside protection, great deal for the student.

Wesley Smith (20:05.506)
Right, right. Well, and and none of this works unless you do what you you what you you you talked about initially, which is you find the most critical need in the workforce and you have to have employers that are bought in, right? So Debbie, tell us a little bit about the employer partnership in this in in this program and the critical role that employers play.

Justin Bakule (Social Finance) (20:17.404)
Correct.

That’s correct.

Debbie Mazur (20:31.845)
Yes, absolutely. So Wes, let me share with you that as we’re having conversations with employers, you know, there are some patterns and some trends that are revealing themselves in different different ways related to our hospital workforce shortages. first, I’ll share that the workforce shortage still exists, but the way it reveals itself in one hospital in comparison to another is completely different. So at one hospital, there may be a shortage specifically for a specialty area.

For another hospital, it may be that they’re struggling to fill talent for specific shifts. And in other hospitals, it might be that the shortage is so broad that they just simply need a pipeline of talent from their community. So every single hospital’s circumstance for as it relates to the nursing shortage is definitely unique and renew fits to solve these problems wherever they are.

Now there’s some patterns that we realize that employers have been putting in place to help to solve for their nursing workforce challenge. And these patterns are things along the lines of implementing contract labor or travel nurses. And we all know that travel nurses cost a significant amount more than a traditional nurse that’s graduated with their BSN program. The other pattern that we see is that turnover rates continue to exist.

In the first year and beyond the first year. So those high turnover rates still exist within the nursing workforce and within the hospital system. And again, Renew can help by incentivizing those students through the repayments to stay longer within that organization. And then finally, another thing that we’re seeing, Wes, is employers, specifically hospitals, are offering sign-on bonuses for nursing talent. And we also know that this is a really short-term solution.

With Renew, what we’re offering is not only a pipeline from the local community to solve for the nursing workforce shortage, but also the ability to have a long-term retention strategy through the incentivized loan repayments for that pre-licensure nurse.

Wesley Smith (22:47.126)
Right, right. Well, I I think that clearly hospitals and and and and those who are in need of nursing as an expertise in in their workforce, they have a lot of reasons financially to look for a different way to do business. This is I mean, the current way that we’ve done this has produced these massive shortages and all of the employers they just don’t have a stable workforce. So

The risk in saying, okay, let’s change the way that we do this, let’s let’s focus on retention, let’s focus on increasing the pipelines. It makes it a lot of sense to me for an employer to say, okay, we’re ready, we’re ready to try something new. Is that is it are are you feeling like from employers that that they’re recognizing that as well?

Justin Bakule (Social Finance) (23:32.166)
Yeah.

Justin Bakule (Social Finance) (23:37.203)
I think there’s two things in particular that from your question, Wes, that I would point to that are unique in this circumstance. One of the clear reasons for the shortage, and we see this across other parts of our portfolio, is for most institutions an inability to react to a job market by expanding their pipeline, meaning the educational institutions themselves. So number one, with WGU, you have growth potential.

That far surpasses most local institutions and ability to expand, right? And that I really cannot be understated as part of the advantage here. Number two, the WGU educational modality of a hybrid education. In particular, one of the things that Debbie’s pointing at is we run into rural hospitals all the time, or we run into certain locations. Now, when I have an educational modality that enables a clinical rotation.

Not in a big city like Boston or Salt Lake City, but in every little community for which there is a student co-located, I’ve strengthened the pipeline of ability to attract and retain someone. Because what we know is if you’re in a small community, the likelihood, say that someone’s gonna come from Boston and then move to that small community after a nursing school is pretty limited unless the person was from that community. But with WGU, now I’ve we’ve unlocked a way.

through the learning modality to have you learn in your location, do your clinical rotation in that location, and then ideally have this financial mechanism, which then incents the person both to stay and stay with their local employer. So that kind of matching and that kind of scalability is quite unique in this picture.

Wesley Smith (25:15.405)
That’s re

Wesley Smith (25:20.142)
Yeah, absolutely. And and anybody who’s done work, you know, on rural issues knows that the you know, the brain drain or the talent fleeing rural areas is a real problem for for these rural communities. And this looks like a solution, a part partly a solution for that. L you can train there, you can stay there, you can support a family in your rural community in healthcare.

Justin Bakule (Social Finance) (25:40.646)
Right.

Right. So a very common conversation we may have, especially in the healthcare industry, in a in a hospital context that’s rapidly consolidating, is you might talk to a large hospital system for which their academic medical center cornerstone location is in a big city.

They don’t typically have an attraction and retention problem. And you hear quite the opposite. we don’t have any more capacity for clinical rotations. We have too many people. We can take the best of the best. People want to come here. They view this as a destination. However, we’ve also acquired all these other hospitals that aren’t that cornerstone. And lo and behold, we see these problems manifested across our system. Or we still work with independent systems and talk to them that are in these kinds of locations.

And they have a real hard time both developing the talent and retaining it within wherever they’re located.

Wesley Smith (26:36.184)
Right, right. Well, this has been really interesting. And to learn more about Renew has been very helpful. I want to end with this question for the three of you. Let’s let’s go all three. I would love advice that you have for other institutions or employers or even finance partners who are interested in building something like Renew. What what would where would you encourage them to start? What are the things that they need to think about if they want to be

You know, on the innovative finance side and figuring out solutions for their students. So with that, Bob, give us give us your advice.

Bob Collins (27:13.985)
Yeah, I would recommend institutions identify certain certain student populations that are more likely to need those fine meet those financing gaps. you know, based on your programs of study and and the cost of attendance, things like that. So certainly working with that and then prioritize how you get low to moderate income access. Remove those financial barriers. I think that’s the most important thing.

Wesley Smith (27:37.55)
Great. I like I like that idea, you know, identify the the students that you want to make an impact on the most and then work from there. That’s probably solid advice for almost everything in higher ed, right?

Bob Collins (27:49.986)
Indeed.

Wesley Smith (27:50.926)
Debbie, what’s your advice?

Debbie Mazur (27:53.862)
Yes, so for for my lens, as we’re working with these hospital partners, there is a tremendous amount of talent that’s on the front line within these hospital systems. Think about our patient care technicians, our environmental services workers, our transporters, and many of those folks, those low to mid-in income earners, are are looking for opportunities. They’re aspiring to be a nurse, but they just don’t have a path forward. And Renew with the WG Partnership unlocks that opportunity.

For that internal career mobility and economic mobility for those employees within the organization. So my advice is to really look under the hood and see if there’s opportunity within their organization to fill their pipeline with a solution like the WGU Release Renew solution to build a long-term sustainable strategy.

Wesley Smith (28:44.054)
Right, right. That that makes a lot of sense as well. Justin, we’ll give you the final word. Give give us some advice.

Justin Bakule (Social Finance) (28:48.262)
Sure. Two two thoughts. to pick up, I think as an organization for social finance, we start and end with the learners. So I agree with Bob’s centering on the learners. And I think the most productive question we’re often asking and answering within a design phase is looking long and hard at really what is the financial barrier getting in the way of persistence. And Wes, what I would tell you is for instance, in Massachusetts, we have a program where community college is free, right? So people say, well

What what would you need to finance? Turns out, you know, for an adult learner, a living expense loan to drive persistence is a needed element, even in a context where tuition is completely free. So really asking yourselves, what’s the barrier in the way of success? And then to pick up on what Bob and Debbie both said, especially if your orientation is around workforce and outcomes and jobs and being you know, as as focused on that as you can be.

I think really having persistence and patience on the employer side to to work to solutions that align with what employers need and are willing to pay for is really important.

Wesley Smith (29:58.86)
Yeah. Yeah. I think that as I look at the renew program, I think so many things lined up perfectly. But the biggest one is the demand by employers. And bringing employers in as payers and and being able to renew the fund with that. very, very helpful. I I can imagine that there are other areas in the workforce that that have similar dynamics that people would want to explore.

Justin Bakule (Social Finance) (30:25.166)
Absolutely.

Wesley Smith (30:26.668)
Well, thank you all for joining us today. Bob, Debbie, Justin. We’re we’re appreciative of the expertise that you shared with us and good luck on the program.