Public Sector Solutions, Children & Families, Results-Based Funding
The first year of the latest outcomes rate card offers learnings not just for the State of Connecticut and its home visiting providers but also for other jurisdictions looking to start similar outcomes-based initiatives.
Home visiting providers surveyed who report that rate card payments are significant
Since 2017, Social Finance has worked with the Connecticut Office of Early Childhood (OEC) to design innovative outcomes-based funding solutions that help the state better support children and families. In particular, we’ve helped the OEC develop a series of outcomes rate cards for home visiting services that carefully define outcomes metrics for the state’s contracts with service providers and reward providers with additional funding when families achieve these metrics.
A year ago, Social Finance and OEC launched a sixth outcomes rate card that will be active from July 2021 through June 2023. Based on the first year’s results, we are excited to share that metric achievement rates align with expectations, and numbers of metric achievements are higher than expected for three out of the four metrics.
The results have helped set a baseline for the performance of the home visiting system on priority outcomes and enabled the partners to identify specific areas of strength and development for providers. OEC and Social Finance have discussed the results in individual meetings with providers, where providers can contextualize the numbers with additional context that influences performance. Along with these successes, some providers reported challenges coordinating within regions and establishing partnerships with referral partners. OEC intends to proactively address challenges to improve rate card metrics over the next year.
The results have helped set a baseline for the performance of the home visiting system on priority outcomes and enabled the partners to identify specific areas of strength and development for providers.
Looking ahead, OEC hopes to elevate and replicate effective strategies used by providers to meet rate card metrics—such as hiring multicultural and multilingual staff on the key population enrollment metric; partnering with doulas and OB/GYN departments on the prenatal enrollment metric; and referring families to English as a Second Language (ESL) classes to meet the caregiver education and training or employment metric.
What we’ve learned: design based on shared goals & execute with fidelity
The first year of this outcomes rate card offers learnings not just for the State of Connecticut and its home visiting providers but also for other jurisdictions looking to start similar outcomes-based initiatives. Above all, we’ve learned that alignment on goals is critical to successfully launching such a project. Jurisdictions that are considering their own initiatives should have clear answers to two foundational questions: (1) what actions can providers take to meet the overall policy goals and outcomes for families intended by the program? And (2) which approach will best incentivize providers to take these actions?
On the first question, Social Finance partnered with OEC during the RFP stage to clearly define the overarching goals and strategy for Connecticut’s home visiting system. We chose rate card metrics that aligned with this strategy and prioritized metrics that providers could directly influence. However, in a recent survey on OEC’s current rate card and in subsequent conversations, some providers found the metrics to be incongruent with their roles as home visitors and with their program models. While the metrics included in the rate card reflect OEC’s overall priorities, in any specific case, a home visitor might best serve a given family without achieving all the rate card metrics. Balancing a set of standardized, system-level priorities with the nuances of serving individual families is a common challenge for any metric-focused initiative. Doing so often requires tradeoffs between different stakeholder perspectives. To meet this challenge, we recommend that jurisdictions triangulate between existing evidence bases, community and provider needs, and other policy priorities.
In terms of the approach, OEC has historically tied monetary incentives to metrics, which is just one possible incentive structure. This incentive resonates with most providers we surveyed: over 80% report that rate card payments are significant and nearly 80% find the rate card to be a motivating tool. However, some providers would prefer funding to be included directly in their contracts and not tied to metric performance. In fact, other agencies that Social Finance works with, such as the Texas Department of Family and Protective Services’ Prevention and Early Intervention (PEI), use a scorecard: a performance management tool similar to a rate card that does not tie payments to metrics but does help providers see their performance relative to other similar programs. Using this performance management approach while directing incentive payments toward service delivery and operating costs might be a more impactful way to help a system to achieve outcomes.
Tied to this second question is a third: how effectively will a jurisdiction execute its preferred approach? In Connecticut, tying payments to metrics establishes mutual accountability: contractors must achieve outcomes and report data, and jurisdictions must validate results and make payments. But doing so also raises the stakes—an agency’s ability to report metric progress and make timely payments is critical to the rate card’s success. In OEC’s current rate card, the payment process has, at times, delayed discussion of metric results and shifted the emphasis of the tool away from performance and toward the potential incentive payments. At the same time, because the rate card requires OEC to make payments based on family-level outcomes, it necessitates that additional attention is spent confirming and analyzing results to ensure accurate payments. Feedback from providers indicates that metric reporting and payment distribution could continue to be improved.
Over the next year of the rate card, we look forward to helping OEC to report and pay out on metric results, create a more frequent feedback loop with providers, and better understand families’ goals for early childhood programming in Connecticut.
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