Program-rich. — Outcomes-poor. The case for a connected Durham.

Section IDurham at a crossroads

Durham is growing. Census data shows the city and county growing faster than the state average over the past decade¹. New housing is going up. Investment is flowing in. The Research Triangle's gravitational pull has pulled Durham into a higher orbit than many demographically similar cities ever reach.

This growth is not evenly distributed. Neighborhoods that have anchored Durham for generations are seeing their costs of living outrun their incomes. Displacement is real and documented². The outcome disparities that have defined the city for decades — in health, in education, in economic mobility, in incarceration and re-entry — are not closing at the rate the investment dashboard would suggest they should be.

Meanwhile, the organizations working on those disparities — the seventy-plus members of the ReCity Network, the hospitals and clinics of the Triangle, the schools and training programs, the faith communities and civic groups — are doing their work with a level of quality and commitment that few cities can match.

Why, then, are outcomes not improving faster?

Durham's growth is real, but it is outpacing the coordination capacity of the programs meant to serve it.

Section IIProgram-rich, outcomes-poor

Consider what happens today when a Durham resident walks into one of the community's food pantries needing help.

The intake worker takes the person's name, their household size, their address. They learn that the family has been without reliable housing for three months. They learn there is a child with an untreated asthma condition. They learn the primary earner lost their job when the bus line to their employer was rerouted.

The food pantry does what food pantries do: it provides food. Well, and with dignity. The intake worker may also hand the person a paper list of other organizations — a housing assistance program, a pediatric clinic, a workforce development nonprofit, a public transit advocacy group.

The family leaves. They may visit two of the five places on the list. Or three. Or one. They will tell their story again at each one. Some of those conversations may lead to help. Others will end in "we don't have capacity this month," or "you need a different referral first," or "call us back in two weeks."

No single part of this is a failure of effort. Every organization involved is doing meaningful work. But the system, taken as a whole, is not a system. It is a collection of programs that happen to be in the same city.

We call this being program-rich and outcomes-poor: the condition of having substantial service capacity that produces far fewer outcomes than its inputs would predict, because the capacity is not coordinated. Durham is not uniquely program-rich and outcomes-poor. Most American cities of its size share some version of this problem. But Durham has two advantages that make it a particularly good place to show what a solution looks like.

First: ReCity already exists.

An actual convening body that already has relationships with more than seventy organizations across six SDOH focus areas³. The connecting tissue does not need to be invented from scratch; it needs to be operationalized. This is a rare head start.

Second: a community posture.

Durham's civic culture is oriented toward coordination and shared investment in outcomes. The partnerships that define this city — across philanthropy, public health, economic development — have already shown a willingness to move past territoriality. That posture is a precondition for what we propose next.

Section IIIWhy more programs won't fix this

There is a standing temptation, when outcomes fall short, to fund another program. The instinct comes from a real place: programs are visible, fundable, measurable at the program level, and they deliver immediate value to the people they touch.

But adding programs to a coordination-starved system produces diminishing returns. A new food pantry in a city with ten food pantries does not triple the number of families fed; it often just rearranges which families go where. A new workforce training program without connection to transportation, childcare, and basic-needs support yields completion rates that disappoint its funders. And at scale, the administrative cost of each organization independently screening, intaking, assessing, and tracking its participants grows roughly linearly with the number of organizations — while outcomes grow more slowly.

This is not hypothetical. It is visible in the financial reports of human-services nonprofits across the country: per-participant cost climbing year over year, outcome metrics flat or declining, staff burnout rising.

The alternative is to invest in the infrastructure that makes the existing programs work together.

Build connective tissue rather than more tissue of the same kind. This is what a Community Information Exchange is, and it is what this partnership proposes to deliver.

Section IVWhat a Community Information Exchange is

A Community Information Exchange, or CIE, is software that enables a network of community-serving organizations — nonprofits, government agencies, clinics, social service providers — to coordinate care for the people they share in common. At its simplest, a CIE does four things.

It maintains a shared directory.

Accurate, consent-based, and up-to-date information about what each participating organization offers, to whom, and under what conditions. This is already more than most communities have.

It tracks referrals as closed loops.

When a food pantry refers a family to a housing support program, the CIE registers that the referral was made, that the housing program received it, that the family was contacted, that services were (or were not) delivered, and what the outcome was. "Referral sent" is the beginning of the loop. "Outcome documented" is the close.

It holds a person-centered record.

Under the person's explicit consent, a unified record can travel with them across the participating organizations. The family does not tell its story five times. It tells it once, to the people it chooses to share it with, and the people in its care team — food pantry, housing counselor, pediatric nurse, workforce coach — can see enough of that story to do their part well.

It measures outcomes at the network level.

Not "referrals sent." Not "services attempted." Outcomes — did the family achieve housing stability, did the child's health condition resolve, did the earner return to employment. These measurements are what funders, agencies, and the community itself need to see.

Critically, a CIE is not a replacement for any of the existing systems. The food pantry keeps its client management software. The hospital keeps its EHR. The workforce nonprofit keeps its Salesforce. The CIE sits above and between them, as the coordination layer. It is also not a directory. Directories tell you what exists. A CIE helps something actually get delivered.

Section VWhy this works where other approaches don't

The reason a CIE works is structural. It aligns with three facts about how community services actually function.

Most programs do not operate in isolation. A family's path through "help" almost always crosses multiple organizations. A CIE makes that path navigable instead of making each organization re-intake, re-assess, and re-approximate.

Trust is the binding agent. Communities don't hand their data to a platform because the platform has the right features. They do so because the platform is implemented by organizations they trust, governed in ways they trust, and with consent terms they can see and change. The partnership structure we propose — ReCity governing, TogetherNow implementing, IBM building the platform — is designed to earn that trust.

Outcomes at the network level are what funders and policymakers are increasingly being asked to produce. A CIE is the only tool that produces them at scale and in real time.

This is why Community Information Exchanges are not new. California, Arizona, New York, Michigan, and others have deployed them with varying degrees of success. What we know from that body of experience is that two factors predict whether a CIE will produce outcomes: the strength of community governance, and the experience of the implementation team. Technology, surprisingly, is rarely the limiting factor — modern platforms are capable enough that the software is the least of it.

Which brings us to what Monroe County has proven.

Section VIMonroe County — what TogetherNow has built

In Monroe County, New York, TogetherNow runs one of the most established Community Information Exchanges in the United States, built on IBM's Connect360 platform.

That is the share of referrals that reach a documented outcome for the referred person. Referral sent, referral accepted, person contacted, service delivered, outcome recorded.

For context: the industry baseline for closed-loop referral completion in community-services networks is typically cited at 3 to 5 percent⁴. The Monroe number is not a modest improvement. It is an order-of-magnitude-plus difference, sustained at scale — meaning across dozens of participating organizations, thousands of referral events per year, and a diverse set of service types from food access to housing support to chronic disease management to workforce re-entry.

What explains the gap? It is not the platform alone. Other communities have used equivalent or similar platforms and achieved numbers much closer to the industry baseline. What TogetherNow brings is operating discipline — the playbook for provider onboarding, the cadence of outcome review, the governance structures that keep participating organizations engaged, and the implementation choices that minimize the friction of daily use for front-line staff.

This is why the Durham deployment will not be built from scratch. TogetherNow brings the operating model that made Monroe work. The Connect360 platform brings the technical foundation. ReCity brings the community. The combination is designed to reproduce Monroe's outcome profile rather than to reinvent it.

Section VIIBeyond SDOH — re-entry, workforce, and the Durham relevance

The Monroe deployment was initially shaped around classic social-determinants-of-health use cases: food insecurity, housing stability, chronic disease management, behavioral health access. Those are the domains where closed-loop completion was first measured.

But the same platform — the same closed-loop mechanics, the same governance structures — has been extended to more complex use cases.

Re-entry from incarceration.

A returning person's success depends on coordinating housing, ID and documents, behavioral health, healthcare, and workforce simultaneously. The standard failure mode is that each service is its own fresh first impression — the person leaving incarceration tells their story to every provider, chases every paper trail, and the first three weeks post-release become an uncoordinated scramble during the time of highest risk. A CIE changes that pattern. A release-planning conversation can generate coordinated referrals across the whole care team. The first weeks become connected, not consecutive.

Workforce transitions.

Job training is necessary but rarely sufficient — transportation, childcare, health care, and stable housing are typically the determining factors for whether a placement holds. A CIE is the only tool that actually coordinates those basic-needs services with the training program itself, which is why workforce development programs using CIE infrastructure tend to produce meaningfully better 12-month retention than those operating alone.

These are exactly the domains where Durham faces some of its deepest equity challenges. Durham's re-entry population interacts with a fragmented set of services where the cost of coordination falls on the person leaving incarceration — who is the least equipped to navigate it. Durham's workforce development programs have strong graduates but persistent post-placement retention challenges that often trace back to basic-needs instability.

The platform does not change what each organization does. It changes what the organizations can do together.

This is why the partnership framing centers Durham's need, not Monroe's precedent. Monroe proved the mechanism. Durham's task is to apply it to the shape of its own gaps.

Section VIIIThe partnership — why these three

Every serious CIE deployment rests on three capacities. Some deployments try to hold all three in one organization; most fail. The Durham partnership deliberately distributes them.

ReCity Network holds the community mandate.

Without ReCity's relationships — across seventy-plus member organizations³, with hundreds of staff and volunteers, and across the six SDOH domains — this is external technology arriving at a Durham community without the permission or participation it needs. With ReCity's relationships, governance, and convening role, the CIE becomes a piece of infrastructure the community itself controls. ReCity does not become a technology vendor. ReCity keeps doing what it does: convening, capacity-building, and making the network work.

TogetherNow holds the operating expertise.

Running a CIE is not a technology project. It is a continuous coordination effort across participating organizations — with its own operating rhythms, provider-support practices, data-quality work, and outcome-review cadences. TogetherNow has done this at scale for years in Monroe. The Durham deployment uses the same playbook — adapted for Durham's partners, community governance structures, and priority domains, but not reinvented from first principles.

IBM Consulting holds the technology platform.

Connect360 is the software. IBM brings the enterprise security posture, the federal compliance pathways (HIPAA, HITRUST, 42 CFR Part 2, FedRAMP-aligned), the interoperability with healthcare and public-sector data standards (FHIR, HSDS), and the roadmap that makes the Durham pilot a credible foundation for regional or statewide expansion when the time comes. IBM does not run the platform in Durham. The community runs it. IBM builds and maintains it, and ensures that it meets the requirements that agencies, health plans, and federal programs increasingly expect.

Each of the three partners can articulate what the other two bring without defensiveness. This is unusual. It is also a precondition for the partnership to work.

Section IXWhat gets built first

The proposed Durham deployment is phased. Phase 1 is a community pilot focused on ReCity's existing member network. Phase 2 is expansion into adjacent organizations and beyond the ReCity convening network. Phase 3, if Durham chooses it, is regional and state-level connectivity.

Phase 1 — Durham pilot, months 1–12

The pilot establishes the core capability: directory of services, anonymous and authenticated referral flows, closed-loop tracking, configurable intake and outcome forms per provider, a community-facing well-being check-in with matched recommendations, basic analytics, and the governance model that makes the network function.

Eighty-five service provider staff from ReCity member organizations are onboarded. Around fifty authenticated community members come through the full platform experience; anonymous usage is expected to be much larger. Two platform administrators from the ReCity team manage the ongoing operation.

The pilot is intentionally scope-reduced from a full Connect360 deployment. What it demonstrates: that Durham can produce Monroe-comparable outcome numbers with a smaller network, at a fraction of the cost, in a fraction of the time.

Phase 2 — Durham expansion, months 12–24

With Phase 1 outcomes in hand — and a community governance structure that has had a year to mature — the deployment extends. More provider organizations beyond the initial ReCity core. Deeper integration with the Durham healthcare system. Connection to Durham County Department of Public Health, NC Medicaid, the Healthy Opportunities Pilot where appropriate, and other public-sector partners.

Phase 2 is where the infrastructure starts to produce the kind of data that matters at the policy level: Durham-wide service coordination volume, outcome rates by domain, equity gap closures by neighborhood.

Phase 3 — Regional and state connectivity, months 24+

If Durham chooses to continue expanding, the deployment becomes one of potentially several CIEs across North Carolina, with the ability to share data — under community-controlled consent — across regions and agencies. This is when statewide policy value emerges: NC agencies can see system-level outcomes; other cities can learn from Durham's governance model; federal programs can be modeled more cleanly.

At every phase, ReCity retains governance. TogetherNow retains implementation authority. IBM retains platform responsibility. None of those roles shift as the scope grows.

Section XWhat we ask of North Carolina

This Point of View is written to invite specific action from specific audiences.

To the North Carolina General Assembly

Support coordinated infrastructure as a distinct category of investment. Program-rich, outcomes-poor is not a Durham problem. It is a North Carolina pattern, and it has been solved elsewhere. The durable way to close outcome gaps in the state is not more programs — it is connecting the programs the state is already funding. A modest, phased state-level investment in CIE infrastructure, anchored by a demonstrated Durham deployment, would return out-year outcomes per dollar that no single new program can match.

To North Carolina agencies

DHHS, the Department of Insurance, the Department of Commerce, the Department of Corrections, and their peer agencies: view CIE infrastructure as the connective layer across the programs you already administer. The data standards (FHIR, HSDS) are ready. The federal compliance pathway is cleared. Your existing reporting requirements can be met and improved through a CIE with less burden on the organizations submitting to you, not more.

To North Carolina health plans and health care systems

The CIE is where value-based care meets social determinants. Your network of community partners is real. The coordination between your clinical care and community-based services is, in most cases, manual and incomplete. CIE infrastructure closes that gap. Participation in a community-governed network is where value-based population health moves from aspirational to operational.

To philanthropic funders across the region

The outcomes you already fund can be multiplied by funding the connective tissue. A grant to any given Durham organization produces activity. A grant to the infrastructure that connects those organizations produces systemic outcomes — the kind of return that funders increasingly demand.

To Durham itself

This is yours. ReCity is the convening body. The governance is the community's. The platform is a tool, not a solution. The partnership with TogetherNow and IBM is configured so that the decisions about how the network operates, what it measures, what it prioritizes, and who is in it are the community's decisions — in every phase, through every expansion.

Section XIThe window is now

Durham is growing. The programs are already here. The infrastructure — the connective tissue — is not. We know it works, because Monroe County has been using it for years, and we know what it produces at scale. We have a community convening body ready and capable, an implementation partner with the playbook that made Monroe work, and a platform partner with the compliance and scale path the next decade of this work will require.

What's missing is the decision — from a handful of actors in the state, from a handful of funders in the region, from the philanthropic and civic leaders of Durham — to invest in the connective tissue rather than in more programs of the same kind.

Durham has the programs. It deserves the outcomes.