With funding from the Social Innovation Fund, Third Sector conducted a feasibility assessment for the Center for Evidence-Based Policy at Oregon Health & Sciences University’s (CEbP at OHSU or the “Center”). Such efforts assessed the likelihood for The Center to develop a performance-based pilot project within the state of Oregon focused on reducing interactions with child welfare and foster care departments among high risk children under six years of age. Third Sector supported The Center’s engagement with likely government end payers and identification of an intervention model that service providers could execute.
Sub-Recipient: Center for Evidence-based Policy at Oregon Health & Sciences University
Established in 2003, the Center for Evidence-based Policy at OHSU is a national leader in evidence-based decision making and policy design. The Center works with federal, state and local policymakers in more than 25 states to use high-quality evidence to guide decisions, maximize resources and improve health outcomes. The Center works with a wide range of stakeholders to improve public policy through innovation, collaboration, and use of best practices. The Center’s Pay for Success initiative, Pay for Prevention (P4P) was launched during the feasibility assessment led by Third Sector, and reflects project findings and user-friendly tools accessible to the public
Motivation for Exploring Pay for Success
Under the leadership of Congressman Earl Blumenauer, D-OR, and a broad steering committee of elected officials, health systems, charitable foundations, and child advocates, the Center has methodically researched the factors leading to foster care placement. These efforts have engaged local, community-based service providers with the goal of improving evidence-based services that prevent neglect, abuse, and foster care entry – one of the leading efforts in the state that merges data analytics and policy. The Center sought technical assistance from Third Sector for the exploration of a Pay for Success program, specifically how to (i) best deploy data learnings into government contracting and (ii) build the capacity to synchronize government, service provider, and community efforts.
Many communities at the onset of exploring PFS often lack an established intermediary that is willing and able to invest substantial time and resources into a data performance platform. The feasibility engagement enabled the Center to establish the foundational elements of a sustained effort that will serve as a dedicated resource for Oregon service providers and government end-payers for any data-driven initiative to improve outcomes for those most in need. Those key milestones included accessing state data, linking that information across various isolated databases to unique birth records, and analyzing the dataset to develop an advanced statistical model that identifies children who are at high risk of maltreatment and neglect.
Third Sector aligned those efforts in the PFS feasibility assessment to:
- Evaluate the Center’s efforts for collecting, analyzing, and acting on state data to create a PFS project
- Support the landscaping of service providers with an evidence-based intervention to reduce the number of children, ages 0-6, experiencing neglect or entry into the foster care system
- Identify and support a government partner willing and able to pay for measureable reductions in the number of children who may enter the foster care system due to demonstrated harm, abuse, or neglect
- Better understand the various contracting possibilities within the state
These efforts are also aligned with various state department’s objectives to develop a data-driven ecosystem for services and to develop prevention and cost-effective services for at-risk families.
Findings and Insights
Through the PFS feasibility assessment, Third Sector determined that the Center is well-positioned with the key infrastructure required to execute Pay for Success and other performance-based contracting and evaluation functions. More resources and analysis, however, are required in order to identify a willing and able state-level end payer to launch an Oregon PFS project focused on child wellness, foster care, and/or health outcomes. In order to engage an end payer, one intervention model should be selected to anchor discussions around a specific set of deliverable and validated outcomes.
Key conclusions from key work streams include:
- The Center’s Data Effort is a Model to Replicate for any Performance-Driven Initiative: The Center successfully developed data system infrastructure to match state child welfare, education, justice, and self-sufficiency datasets to children and their parents. The assembly of a 10-year longitudinal picture of all children born in the State of Oregon is a resource-intensive undertaking that can serve as the backbone for any performance or policy initiative that can inform government and community organizations and assist them improve services for people in need. For the feasibility engagement, the Center designed geographic hotspot maps and economic analyses to assess the risks and costs of child maltreatment and foster care placement across the state. Conclusions and data tools are publicly available at the Center’s Pay for Success website, Pay for Prevention (P4P). The web portal is an interactive public resource for government, service providers, and other stakeholders.
- Various Oregon Community Organizations are Well-Suited for Pay for Success: Third Sector assisted with identifying key parameters suitable for performance-based contracts and outcomes of interest for the Department of Human Services. Twenty relief nurseries, family support services, and other home visiting service providers in the state were reviewed through a Request for Qualification process to assess the provider landscape in the state. For a project focused on neglect, abuse, and foster care outcomes, a relief nursery or a family support provider are best suited so long as they demonstrate (i) substantial data capacity for measurement and analysis, (ii) tracking and validation of client outcomes that impact government spending, and (iii) a strong understanding of outcomes among the target population in the absence of the intervention.
- Data Integration Promotes a Culture of Continuous Learning: The Center’s data effort to access and link disparate government data sets generated a decade long holistic picture of the existing challenges of a high-need population. A baseline of outcomes was established for children at risk of foster case placement, which can be continuously updated to assess the needs of the population. This is one of the most challenging milestones for any PFS project, which can ultimately serve as a reference point of comparison in order to rigorously evaluate the impact of any child wellness or foster care intervention. The Center’s data integration effort establishes a wide-ranging analytical foundation for government, researchers, and other community stakeholders to develop a “performance feedback loop” between case managers, service providers, and policy-makers to assess program effectiveness.
- Promising Environment for Ongoing Stakeholder Engagement for Performance Initiatives: Third Sector’s engagement led to an incremental systems change in various areas. For the Center, the data efforts were leveraged to inform how best to design an intervention and contract. Among providers, specific areas for data improvement were identified for the Center to assist with building capacity. With state government, the opportunity to synchronize existing resources to serve those most in need and to promote continuous learning is aligned with the goals of the Department of Human Services. These values can also be aligned with future collaboration with Coordinated Care Organizations (CCOs). CCOs are uniquely positioned to be viable end payers for P4P since they independently administer and appropriate their own budgets and are currently incentivized to achieve specific intergenerational / home visitation outcomes. Engagement with CCOs, however, would require increased focus on interventions with a track record of delivering health outcomes.