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RIP Medical Debt

RIP Medical Debt

Cooked, Document

Yale School of Management
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In office for less than a year, RIP Medical Debt CEO Allison Sesso received word in December of 2020 that the organization would be the recipient of a $50 million unrestricted gift from Mackenzie Scott. Sesso believed that the surprise windfall could be a gamechanger for the organization.

Craig Antico and Jerry Ashton had established RIP Medical Debt as an IRS 501c(3) organization in 2014 with the mission of ending medical debt. The two cofounders had worked in the debt collection industry and knew that overdue medical debt could be bought for pennies on the dollar. Antico and Ashton launched RIP Medical Debt to collect funds, purchase medical debt, and release the debtors from their obligations. When Sesso, who previously served as the Executive Director of the Human Services Council of New York, assumed the role of President and CEO in early 2020, the goal was to grow RIP from a start-up to a robust and sustainable organization.

If anything, 2020 had served to highlight the problems with medical debt. The COVID pandemic created a major health emergency and the protests following George Floyd’s murder had underscored the socioeconomic inequality in healthcare access and health outcomes. Over the year, 350 thousand Americans had died from COVID and life expectancy in the US dropped by 1.8 years.The pandemic had forced increasing numbers of Americans to take on high burdens of medical debt. Furthermore, the devastation of COVID cases and deaths had fallen disproportionately on communities of color.

Scott’s gift was roughly seven times RIP’s annual operating expenses. Eager to use this gift for maximum impact, Sesso had RIP embark on a strategic planning process. In addition to building trust and alignment among her remote team, Sesso wanted to identify the most effective path forward for the organization.

Conceivably, RIP could continue doing what it was doing, but simply do it on a bigger scale. Alternatively, the organization could use the money to improve its core operations in a way that it might work more efficiently - for example creating automated systems to replace manual processes.  Most ambitiously, RIP could rethink its entire operating model to better achieve the organization’s mission - to end medical debt. RIP’s model had been built on an understanding of how the medical debt system worked and its strategy had been to work within that system to retire debt.  However, with this large change in resources, RIP could try other strategies, such as direct advocacy, to better address the root causes of the problem.  

Citation: Liam Grace-Flood and Judith Chevalier, "RIP Medical Debt: What Responsibility and Opportunity, if any, does a Nonprofit have to Advocate for Systemic Change?" Yale Case 23-025, August 28, 2023.