Third Sector Capital Partners, Inc. launched an inaugural Social Innovation Fund (SIF) competition in 2014 to accelerate the development of Pay for Success (PFS) in communities in the United States. The Austin/Travis County Health and Human Services Department (HHSD) was selected to receive technical assistance to explore the feasibility of a teen pregnancy prevention focused PFS project. This feasibility assessment led to key insights that other communities seeking to explore PFS are encouraged to leverage.
- Why PFS? PFS offers the Austin/Travis County (A/TC) community an approach for contracting with and funding providers that can be held accountable for achieving outcomes.
- What’s unique about this feasibility assessment? This feasibility assessment was the only assessment from the SIF competition focused on teen pregnancy prevention. A/TC was also one of the few communities from the competition that explored both SIF and non-SIF feasibility assessments in various social areas at the same time.
- What’s the most important lesson learned? This feasibility assessment faced the challenge of identifying end-payers for a teen pregnancy prevention focused PFS project. The A/TC community engaged in multiple PFS feasibility assessments without a collective agreement on social areas of priority. When several feasibility assessments closed in spring of 2016, A/TC was not certain of which areas to move forward with for PFS project development. Ideally, governments and communities should first identify social areas of priority before engaging in PFS feasibility assessments in multiple social issues.
- What are the next steps? After the closure of several PFS feasibility assessments in the spring of 2016, Travis County and HHSD decision-makers will meet to identify how it would like to engage in PFS. A next phase of TPP feasibility for more data assessment and economic cost benefit analysis was recommended to HHS for the City of Austin, however there has been no decision to move forward due to lack of a project leader in A/TC and no funding Alternatively, the project could be pursued using traditional philanthropic funding as the model is effective in addressing teen pregnancy.
What other outcomes resulted from the project? While not all PFS feasibility assessments will lead to the launch of PFS projects, the work conducted on them can result in systems change in the community. Key innovations ranging from accessing and linking government data sources to designing social service procurement to the implementation of outcomes-based contracting are all valuable to enhancing funding opportunities and contracting decisions for vulnerable populations. In A/TC, the United Way rewrote its guidelines so that grants it awarded would be outcomes-based and HHS began agency-wide performance measurement efforts. Additionally, the Third Sector landscape analysis and provider interviews revealed excitement about using collective action models to achieve priority outcomes.
Feasibility Assessment Overview
This feasibility assessment explored the use of PFS to decrease teen pregnancy among Hispanic females aged 13-19 in Travis County. This feasibility assessment was conducted over 11 months and was initiated by HHSD with support from Travis County, Central Health, United Way for Greater Austin, (UWATX) and Mission Capital. Third Sector led PFS technical assistance and Abt Associates supported data and evaluation technical assistance. A Leadership Team comprised of leaders from HHSD, Travis County, UWATX, Mission Capital, and Third Sector convened regularly to review findings and make decisions throughout the assessment. Third Sector led the assessment of key areas necessary to develop and launch a PFS project:
- Outcome Assessment: Identified teen pregnancy prevention outcomes of priority for potential end-payers.
- Target Population Assessment: Confirmed that Hispanic youth aged 13-19 in Travis County is a sizable population and be reliably referred to the chosen intervention.
- Data Source Assessment: Conducted extensive landscape analysis of interventions to scalable priority outcomes.
- Intervention Assessment: Identified interventions that could achieve outcomes exist and were scalable.
- Economics Assessment: Estimated the quantitative size of a PFS project and impact rates for outcomes prioritized by potential end-payers.
- Evaluation Design: Determined that the evaluation design would be created if there was a next phase in the project.
- Funder Development: Identified future funders who were awaiting the financial model and program data.
Third Sector concluded this feasibility assessment in May 2016 and recommended that the Leadership Team and the Travis County Commissioners Court explore several options for advancing PFS including:
- Move forward with the development of a teen pregnancy prevention focused PFS project. Based on the findings of the feasibility assessment, a teen pregnancy prevention PFS project is viable but would require significant time and resources. This option would entail A/TC designing and launching a PFS procurement for the selection of teen pregnancy prevention provider and evaluator and developing a teen pregnancy prevention program with the intention of transitioning to a PFS project once relationships and operations are tested; and/or
- Engage in PFS without the development of a teen pregnancy prevention focused PFS project. This option would entail A/TC leveraging lessons learned from this feasibility assessment to improve outcomes-based contracting for existing funding streams in other social areas.
Travis County and HHSD decided to schedule independent meetings for its decision-makers to identify priorities before engaging in the development of PFS projects. Ultimately, these meetings will allow A/TC governments to develop a broader movement to explore the fruition of PFS and outcomes-based contracting as a tool to set common goals, metrics, and accountability beyond a one-time project.
- Early prioritization of outcomes by A/TC allowed for more focused work on assessments that would help achieve these outcomes. Third Sector focused on an Outcome Assessment early in the project. As part of that work, the A/TC Leadership Team members discussed which teen pregnancy preventions outcomes that were valued (i) independently as an organization and (ii) collectively as a community. Abt Associates and Third Sector narrowed down the five prioritized outcomes based on the availability of data to (i) reductions of teen births, (ii) postponement of first and subsequent births, and (iii) high school completion and attendance. Due to the early prioritization of outcomes, Third Sector and Abt Associates were able to focus the remaining seven months of intervention, data source, and the economics assessments around elements that would lead to the achievement of these outcomes. HHSD and the A/TC community partners now have the opportunity to leverage these outcomes in the development of a teen pregnancy prevention PFS project.
- An open and transparent procurement process is important for attracting funders to the PFS projects. Many of the teen pregnancy prevention interventions reviewed during the Intervention Assessment measured the increase and progression on knowledge, skills, and attitudes on sexual behavior for those served, while a smaller number of interventions measured the outcomes prioritized by the A/TC Leadership Team. To advance a teen pregnancy prevention PFS project, a committed end-payer would need to conduct an open and transparent outcomes-based procurement to select interventions.
- Prioritize a social area before engaging in PFS feasibility assessments. This will help your community save time and resources, lead to feasibility assessments around those priorities, and may increase the likelihood of the feasibility assessment leading to the development of PFS projects.
- Secure a committed end-payer early in the process before moving forward with the development of PFS projects. Engaging end-payers will determine their ability and commitment to provide success payments in a PFS project.
- If your community is interested in the development of several PFS projects, invest in a project manager. The project manager would (i) ensure that all work-streams necessary for the development of each PFS project progress on a day-to-day basis, (ii) coordinate data requests with the evaluator, (iii) work with the PFS technical assistance advisor, and would (iv) bring in decision-makers as necessary.