The Republican View of Evidence

House Republicans staked their claim to a share of the evidence-based policy movement last week. The proposals were embedded in a larger Republican framework for addressing poverty, the first in a series of such reports that are expected to be released over the next few weeks.

The framework, backed by House Speaker Paul Ryan, is intended to lay the groundwork for a broader vision for government that the GOP can campaign on in the fall, rebranding the party while simultaneously conveying a sense of quiet competence and readiness to govern.

Continue reading SIRC’s column at Government Executive.

Posted in Evidence, Politics

Social Innovation Fund Cut, Other Evidence Programs Funded in Senate Spending Bill

The Social Innovation Fund would be defunded under a FY 2017 spending bill passed by the Senate Appropriations Committee on June 9.

However, the bill included funding for other evidence-based programs, including $120 million for the successor to the Department of Education’s i3 program, called the Education Innovation and Research (EIR) program. The bill also provided $101 million for the evidence-based Teen Pregnancy Prevention Program (TPPP), according to the National Campaign to Prevent Teen and Unplanned Pregnancy.

The Social Innovation Fund (SIF) has been routinely defunded by congressional Republicans in previous years at this stage of the appropriations process, only to see its funding restored in later negotiations with President Obama. Like many of the administration’s evidence-based initiatives, it is closely associated with the president and opposed by many congressional Republicans primarily on that basis.

The results of such negotiations are not automatically benign, however. Last year, SIF’s spending was reduced from $70 million to $50 million.

Meanwhile, one of the SIF’s selling points to congressional Republicans — its pay for success program — may be lost if Congress enacts separate legislation sponsored by Reps. Todd Young (R-IN) and John Delaney (D-MD). That bill has already been approved by the House Ways and Means Committee and there is a companion bill in the Senate. The legislation would shift much of the federal government’s work on pay-for-success to the Treasury Department, with unknown consequences for SIF.

Unlike in past years, President Obama will probably not be in office when final negotiations occur on this bill. Spending legislation during presidential election years is often delayed until after the election and handled in negotiations with the new administration. SIF’s fate may ultimately depend on the outcome of the presidential election this fall.

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Posted in Evidence, Social Impact Bonds / Pay for Success, Social Innovation Fund

P3 Waiver Authority Would Be Extended Under Senate Bill

Waiver authority under the Performance Partnership Pilots (P3) program would be extended by up to five years by spending legislation approved by the Senate Appropriations Committee on Thursday.

According to language in the bill that covers the P3 program:

(c) Pilot sites selected under authorities in this Act and prior appropriations Acts may be granted by relevant agencies up to an additional 5 years to operate under such authorities.

The new language aligns with recommendations in a recent SIRC report on P3, which was released earlier this week and covered in stories in Education Week and Government Executive magazine.

The committee also included additional instructions in the accompanying Senate report that also reflect SIRC’s recommendations:

The Committee also notes that thus far a number of factors have led to a more modest start to utilizing flexibility available to pilot sites. The Committee urges the administration to enhance its efforts working with existing and new sites on the full range of flexibility that could be employed to improve outcomes for youth served through pilot sites. Further, the Committee bill also includes language extending the flexibility for current and future pilot sites by up to an additional 5 years in recognition of the challenges associated with implementing sustainable, positive change in systems serving this population. Finally, the Committee directs the administration to continue to provide annual reports providing the following information: detailed summary of all involved pilot programs, overview of how pilots were selected, summary of findings from the various pilots, and recommendations for Congress on how to apply any best practices learned more broadly.

The proposed language in the Senate bill is not final, however.  The legislation must still be approved in the House and signed by the president. Spending bills often are not finalized until after the beginning of the fiscal year. In this case, the legislation  probably will not be enacted in final form until after the presidential election this fall.

Meanwhile, the Obama administration is still accepting applications for a second round of up to 10 awards, with a due date later this month. A third competition is expected later this year. The legislation adopted in the Senate would authorize a fourth round next year.

Posted in Children and Families

Evidence-based Prevention Services to Receive Boost in Pending Child Welfare Legislation

On June 10, the House and Senate released the text of a bipartisan, bicameral child welfare reform bill that would substantially increase funding for evidence-based prevention services. The House Ways and Means Committee is expected to take up the legislation (HR 5456) on June 15.

Under the legislation, states could use federal child welfare entitlement (Title IV-E) funds to cover the cost of up to 12 months of preventive mental health, substance abuse, or in-home parenting programs for children at risk of entering the foster care system and/or for their parents or caregivers. Pregnant or parenting foster youth are also eligible.

Federal funding would subsidize a portion of state costs, similar to the matching rates used for other entitlements like Medicaid. According to a preliminary estimate from the nonpartisan Congressional Budget Office, the cost of these prevention-oriented services would be partly offset by keeping families together and reducing the use of more expensive group homes for foster children.

To qualify for federal funding, the services must meet the bill’s standards for practices that are promising, supported, or well-supported by evidence (as defined below). Starting October 1, 2019, at least half of the federal share of funding for such services must meet the highest (well-supported) evidence standard.

The Department of Health and Human Services is directed to issue a pre-approved list of services that satisfy the bill’s requirements by October 1, 2018 and to update the list as often as it deems necessary. The legislation also authorizes the creation of a clearinghouse for evaluating research on these services.

Update: The House Ways and Means Committee approved the bill on June 15. It is now awaiting consideration on the House floor and in the Senate.

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Posted in Children and Families

Performance Partnership Pilots: An Early Look

The Social Innovation Research Center has today released a report examining the early progress of the Performance Partnership Pilots (P3) program.

First authorized by Congress in January 2014, P3 allows projects that are focused on youth to align and better coordinate federally-funded programs and services.  The program permits projects to request waivers of certain federal restrictions and to potentially consolidate multiple funding streams.

Although focused on a particular subset of youth – those who are disconnected or at risk of becoming disconnected from education or the workforce – the program is seen as a possible model for increased federal flexibility, with broader potential implications for other social programs nationally.

This paper examines the early progress of this initiative.  It is based on a review of project grant applications and performance agreements, interviews with six of the first round pilots, and interviews with federal officials overseeing the program.

The paper also includes full summaries of each of the first nine awardees, including details of their waivers and performance agreements.

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Posted in Children and Families, Education, Government Performance, Workforce Issues

Pay for Success Efforts Roll Forward in Congress, Administration

The still small, but growing, field of pay for success made significant strides this week, with Congress readying pay for success legislation and the Obama administration announcing a second round of grants through the Social Innovation Fund.


House Readies New Pay-for-Success Bill

On May 6, Reps. Todd Young (R-IN) and John Delaney (D-MD) introduced a new version of their Social Impact Partnership Act (H.R.5170). It will be one of several bills considered at a Ways and Means Committee hearing on May 11.

After the Republican Study Committee lent the bill its support in late April, it seems poised for swift passage. However, one unknown is whether the bill will move forward on its own or as part of an anti-poverty package that House Speaker Paul Ryan has been pushing.

The legislation’s prospects are also unknown in the Senate, but the new House bill appears to have incorporated some of the provisions in a similar bill introduced by Sens. Orrin Hatch (D-UT) and Michael Bennet (D-CO) last year.

The new House bill (bill text) reduces the price tag from $300 million to $100 million, switches the lead federal agency to the Treasury Department, and includes a federal interagency council and separate appointed commission of experts to assist the interagency council.

Update: On May 11, the House Ways and Means Committee approved the Young/Delaney bill by voice vote. Before approving the bill it rejected two amendments from Democrats. These included an amendment from Rep. Lloyd Doggett (D-TX) to require 50% of funds to be spent on children. Another Doggett amendment would have extended authorization for the TANF program, but it was rejected on a point of order that it was not germane to the broader legislation. The bill was passed by the full House on June 21. For additional background on the legislation, see this CRS issue brief.


New Social Innovation Fund Intermediary Grants

The Social Innovation Fund (SIF) today announced $6.1 million in new grants to intermediaries under its pay-for-success program, which provides funding for technical assistance and feasibility studies. Intermediaries match this funding and provide subgrants through separate competitions, which are likely to be announced later this year.

SIF’s funding is divided among three intermediaries, two of which also received funding in the first round in late 2014. Eight intermediaries were selected in that first round and, according to SIF, they have provided subgrants to a total of 67 state and local governments and nonprofits involved in PFS projects.

According to SIF, the new grants announced today are:

  • Harvard University Government Performance Lab: With a $2.1 million grant, the Harvard Government Performance Lab will take projects from the feasibility phase to the implementation phase for up to five Pay for Success projects. Since its inception, Harvard GPL has been actively involved in the feasibility and transaction structuring of 26 PFS projects.  The GPL’s mission is to accelerate the pace of progress on tough social challenges by improving the way that governments procure and deliver social services.
  • Local Initiatives Support Corporation (LISC): With a $1.3 million grant, LISC will take projects from the feasibility phase to the implementation phase for three to four service recipients. LISC will identify high-performing service providers that have demonstrated the ability to develop and operate strong evidence-based programs for PFS investment; help standardize content-specific program design and systematize contracting for the social service program; and create a body of high-quality and routinely-collected data across content areas for PFS projects.  In addition to overall project coordination, LISC will raise investment capital for selected projects, undertake financial modeling for Service Recipients, coordinate negotiation of all transaction documents, develop ongoing monitoring and data collection requirements, and support ramp-up activities.
  • Sorenson Impact Center at the University of Utah’s David Eccles School, in partnership with Social Finance, Inc: With a grant of $2.6 million, the Sorenson Impact Center, in partnership with Social Finance, Inc., will provide advanced transaction structuring technical assistance for between four-five service recipients, bringing Pay for Success projects into development in the Western U.S. The partnership will take a proactive and comprehensive approach to help jurisdictions structure projects. This includes assisting organizations with the development of a communications and engagement strategy to support providers, funders and policymakers.

SIF has also been tracking the knowledge gained from its earlier grantees. Last month it released four new reports:

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Posted in Social Impact Bonds / Pay for Success

Obama Administration’s New Performance Grade: Improved, But Work Remains

The Obama administration has made substantial progress in measuring federal program effectiveness, but more needs to be done to shift federal funding to programs that work, according to a scorecard released Monday by Results for America, a bipartisan advocacy organization that supports greater performance in government.

“This administration believes in the power of evidence,” said OMB Director Shaun Donovan at an event announcing the new ratings. “Evidence should drive policy decisions. We need to do what works and stop doing what doesn’t.”

The scorecard rated seven federal agencies, both domestic and international, including the Department of Education, HUD, Department of Labor, and USAID. It was assembled after consulting with more than 75 current and former federal officials and other experts earlier this year.

Most of the rated agencies have made significant progress in embedding the use of performance data and program evaluations in their decision-making, according to the report.  It commended the administration for strengthening federal evaluation offices, adopting agencywide evaluation policies and research agendas, and building out information clearinghouses like the Department of Education’s What Works Clearinghouse.

The agencies received lower scores on integrating performance information into the federal grantmaking process, however. The administration received its worst ratings on cutting or shifting funding away from programs, practices or policies that were not working.

Continue reading SIRC’s column at Government Executive.

Posted in Evidence, Government Performance

New Federal Commission’s Top Task May Be Setting a Truly Bipartisan Evidence Agenda

Efforts to broaden the use of data and research in federal policymaking may receive a substantial boost from a commission created by Congress last month.  The new Evidence-based Policymaking Commission, established by legislation signed by President Obama on March 30, is charged with identifying ways to increase the use of such information. Its most important task, however, may not be coming up with new ideas, but providing a bipartisan imprimatur for ideas that already exist.

Continue reading SIRC’s column at Government Executive.

Posted in Evidence

Medicare and Medicaid Continue Transition to Value-based Payments

Earlier this month, the Department of Health and Human Services (HHS) announced that 30 percent of Medicare payments are now tied to quality or value, nearly a year ahead of goals that it set for itself in early 2015.

According to HHS, over 10 million Medicare recipients are receiving care under alternatives to traditional fee-for-service arrangements. HHS credited most of its progress to the growth of Accountable Care Organizations (ACOs).  According to the department, there are now a total of 477 ACOs participating in its Shared Savings Program and the Pioneer ACO program.

The administration says that the transition to ACOs and value-based care will reduce costs and improve health-related outcomes for patients. It hopes to tie 50 percent of Medicare payments to these models by the end of 2018.

The ACO model is also increasingly being adopted within the Medicaid program. According to a recent report from the Center for Healthcare Strategies, eight states ─ Colorado, Illinois, Maine, Minnesota, New Jersey, Oregon, Utah, and Vermont ─ have launched Medicaid ACO or ACO-like programs, serving a total of more than 2.5 million beneficiaries.

“Value-based purchasing is quickly becoming the new paradigm in Medicaid,” said Tom Betlach,  president of the National Association of Medicaid Directors (NAMD), which released a study of alternative payment models in Medicaid in late March.

These developments suggest rapid advancement in the use of value-based payment systems, but there is enormous variation among them, including the size of their financial incentives and the performance measures that are being used, according to a recent analysis for Health Affairs.

Organizations like the National Quality Forum have been working to support improvements in performance measures. Progress will also depend heavily on advancements in electronic health record (EHR) systems, which are still being rolled out in many health systems and have experienced a number of usability, interoperability, and security problems.

Some provider groups remain skeptical. According to a study released by American Academy of Family Physicians in late 2015, 69 percent of its members said that value-based payments would not improve patient care. They cited a number of barriers, including lack of evidence that using performance measures improved such care, lack of standardized measures, and increased costs in terms of staff time and training.

HHS is working to address these problems through a number of initiatives, including technical assistance and a pilot program for testing new financial incentives, quality standards, and increases in coordinated care.

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Posted in Health, Social Impact Bonds / Pay for Success