Pay For Success Research Articles

Demonstrating Feasibility in Pay for Success - Methodology for Analysis of Efficacy of Successive Early Childhood Service Programs

Pay for Success (PFS) is becoming more widely used to expand and advance innovation in the use of evidence-based programs that address societal issues. Such issues affect at-risk young children and youth, current and former incarcerated individuals, homeless individuals, and families in distress, to name a few. This brief focuses on high quality early childhood programs. The most common way to develop an analytical approach to preparing for PFS feasibility has been to use historical data and an observational perspective to hypothesize on the value of a quality early childhood treatment for an identified group of families/children. To date, most PFS projects have been built on the provision of a single treatment. Data demonstrating treatment efficacy and effectiveness for a single treatment is relatively plentiful (although not necessarily plentifully quality). Program treatments tend to be studied for treatment-specific cohorts for a specific time period. Preparing the required PFS feasibility study becomes considerably more problematic from a methodological standpoint when the PFS sponsors are considering more than one treatment to be offered in succession to the same group of families (“successively” over time). An example is a pre/post-natal home visiting program immediately followed by an in-home parental support/engagement program. An analytical methodology needs to be developed to value the marginal efficacy of each of the PFS treatments based on the time period over which they are delivered. This brief demonstrates how the Difference in Differences (DiD) statistical technique can be extended to PFS programs with successive treatments.

SROI in the pay for success context: Are they at odds?

The Pay For Success (PFS) and Social Impact Bond (SIB) movements to date have focused heavily on shorter-term outcomes that can be monetized and show clear savings to government entities. In part, this focus derives from the need to specify contract payments based on a narrow set of well measured outcomes (e.g., avoided days in jail and foster care, decreased use of behavioral health services). Meanwhile efforts to measure the social return on investment (SROI) of interventions have sought to expand the view of relevant outcomes to include domains that lend themselves less clearly to monetization. This paper explores the intersection between these two movements with illustrations from a SIB initiative underway focused on homeless families with children in foster care. Challenges and potential for SROI in a third-party payor environment will be discussed as well as opportunities to better leverage the strengths of both types of initiative.

Pay For Success And Population Health: Early Results From Eleven Projects Reveal Challenges And Promise.

Pay for success (PFS) is a type of social impact investing that uses private capital to finance proven prevention programs that help a government reduce public expenditures or achieve greater value. We conducted an analysis of the first eleven PFS projects in the United States to investigate the potential of PFS as a strategy for financing and disseminating interventions aimed at improving population health and health equity. The PFS approach has significant potential for bringing private-sector resources to interventions regarding social determinants of health. Nonetheless, a number of challenges remain, including structuring PFS initiatives so that optimal prevention benefits can be achieved and ensuring that PFS interventions and evaluation designs are based on rigorous research principles. In addition, increased policy attention regarding key PFS payout issues is needed, including the "wrong pockets" problem and legal barriers to using federal Medicaid funds as an investor payout source.

Health Impact Bonds: Will Investors Pay for Intervention?

Health Impact Bonds: Will Investors Pay for Intervention?