How SteppingStone Health Built a Strategy that Balances a Strong Foundation with Future Growth

SteppingStone Health operates three San Francisco area Adult Day Health Care centers that deliver medical, social, and therapeutic services to older adults and people with disabilities. A nonprofit certified by the California Department of Aging and licensed by the Department of Public Health, SteppingStone helps clients maintain their health, reduce isolation, and continue living at home and in the community. With services offered in multiple languages and a commitment to serving those with complex health and social needs, SteppingStone is widely recognized as a trusted social services provider in the city’s continuum of care.

• Facilitated SteppingStone’s comprehensive strategic planning process, engaging board, staff, and external stakeholders.
• Established a Strategic Thinking Team to grow leadership capacity, build governance, and ensure implementation of key priorities.
• Conducted in-depth discovery to align aspirations with organizational and external realities.
• Helped leaders recognize the importance of strengthening organizational foundations as the prerequisite for successful growth.
• Developed a five-year strategic framework and implementation template to guide future action.
• Identified revenue diversification, organization modernization, and leadership structure as central priorities for long-term sustainability.

SteppingStone engaged Collaborative Consulting to build on its operational stability and identify opportunities for growth by creating a forward-looking strategy for the next five years. The project aimed to:

• Define a clear vision for organizational growth and community impact.
• Diversify revenue beyond Medi-Cal through grants, philanthropy, private payer, and other revenue opportunities.
• Explore opportunities for service and program expansion, particularly for high-need and underserved populations.
• Establish an internal structure for ongoing strategic thinking and action, ensuring the plan would remain relevant and actionable.

Collaborative Consulting guided SteppingStone through a formal strategic planning process. We began by establishing a Strategic Thinking Team composed of board members and staff leaders, which served both as a governance body for the project and as a capacity-building mechanism for future strategy work.

To ensure the strategic plan would reflect both SteppingStone’s aspirations and the realities of its environment, we grounded the work in a discovery process:

• We collected internal input through interviews with staff and board stakeholders and an online survey for the Strategic Thinking Team. This part of our discovery identified organizational strengths, workforce challenges, and operational gaps.
• We gathered external perspectives by interviewing funders, policymakers, healthcare partners, and peer organizations, identifying SteppingStone’s unique role in San Francisco’s health and social care systems and opportunities for expansion.
• We completed a current-state assessment of the organization, analyzing its operations, workforce, and systems to further ground the strategy in SteppingStone’s operational, cultural, and structural realities.

What emerged from the discovery work was clear: SteppingStone’s ambition to expand services and reach new populations was well founded, but the organization first needed to strengthen its core. We recognized that systems, staffing, and leadership capacity had to be reinforced to support long-term growth, without slowing SteppingStone’s pursuit of current opportunities such as its expansion of Enhanced Care Management under CalAIM. This dual focus of building capacity while advancing growth became the pivot point for the plan.

From here, we worked with SteppingStone’s leadership team through a series of facilitated strategy sessions to review discovery findings, explore scenarios for the future, weigh trade-offs, and ultimately agree on three priorities that formed the backbone of their five-year strategic framework.

Priority Area 1. Financial Growth and Diversification

The plan sets out a path to strengthen financial health by diversifying revenue beyond Medi-Cal. Priorities include pursuing new payer sources, expanding community-based services like Enhanced Care Management, deepening partnerships to meet complex participant needs, and continuing to pursue services for specialized populations.

Priority Area 2. Organizational Development

To support growth, SteppingStone will invest in modernizing systems and strengthening its workforce. The framework emphasizes updating core administrative processes, creating more consistent training and development opportunities, and improving outreach and visibility in the community. Together, these investments build the resilience needed to sustain and scale services.

Priority Area 3. Future Leadership

The plan recognizes the importance of preparing for leadership transitions and building a stronger bench. It calls for rounding out the senior leadership team, strengthening the board, and creating more opportunities for distributed leadership and professional development across the organization. These steps will help ensure SteppingStone has the leadership depth and continuity needed to support long-term growth.

To ensure these priorities lead to action, we also developed a practical implementation template and a structure for continuous strategic thinking and planning. SteppingStone came away not only with a clear plan but also with the capability to carry strategy forward as an ongoing practice.