Pay for outcomes (PFO) is a payment model that promotes innovative financing for social initiatives, connecting funding to outcomes and cost savings. The Bipartisan Budget Act of 2018 allows Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program awardees to implement PFO initiatives. PFO can help awardees expand services, improve outcomes, reach new or underserved populations, and/or engage new stakeholders.
This resource summarizes home visiting research findings to inform PFO feasibility studies and project development, including outcome selection, projected cost savings, and outcome payment pricing for PFO financial agreements. It details statistically significant home visiting outcomes from prior research, potential economic value of home visiting’s impact, and the availability of administrative data sources to calculate return on investment.
The resource includes five components:
- Introduction, which describes PFO, introduces the resource, and offers tips for navigation
- Module 1: Overview of Outcomes Demonstrated in Home Visiting Studies, which presents an in-depth scan of home visiting outcomes achieved by model
- Module 2: Economic Value of Home Visiting Outcomes, which details monetary values researchers have used to establish savings in home visiting return on investment analyses
- Module 3: Economic Value of Outcomes in Non-Home Visiting Research, which summarizes monetary values researchers have used for similar outcomes in non-home visiting studies
- Module 4: Administrative and Government Cost Data Sources, which collates the administrative data sources used in the return on investment calculations
Modules contain a summary of results and individual profiles for each study. Profiles show methods, target population, location, outcome valuation, and cost data sources.
Planning for a Pay for Outcomes Approach in Home Visiting summarizes research findings on home visiting outcomes and their associated costs to support PFO planning. MIECHV awardees, evaluators, and PFO contractors can use this resource to inform PFO feasibility studies and PFO project development, including outcome selection, projected savings, and outcome payment pricing.
Key Findings and Highlights
This resource summarizes prior research to provide information on home visiting outcomes, per unit costs for these outcomes, and the availability of administrative data sources to determine costs. Key takeaways include:
- Feasibility studies assess whether programs are good candidates for PFO. Can a program achieve results and save money, especially future government spending? Prior research can help MIECHV awardees answer these questions.
- Successful PFO projects carefully select one or more meaningful outcomes service providers are likely to achieve. Results from rigorous local evaluation or research literature can show (1) specific outcomes the intervention has achieved in the past, (2) length of time to achieve the outcomes, and (3) effect size.
- Awardees considering PFO may want an estimate of future savings from the project. Published home visiting return on investment (ROI) studies often describe the per unit cost of each outcome measure used in the calculation, data sources informing the per unit cost, and actual savings. Awardees may use the ROI result or apply the per unit costs to the outcomes they have achieved in the past to estimate potential savings.
- MIECHV awardees are encouraged to use local data when possible to inform the PFO feasibility study. Published research can provide insight for awardees in how to use their local data to identify potential outcomes and project future savings or fill the gap when local data are not available.
The study team conducted extensive literature scans to develop Planning for a Pay for Outcomes Approach in Home Visiting.
For home visiting outcomes (Module 1), the study team examined research in the Home Visiting Evidence of Effectiveness (HomVEE) review and consolidated favorable demonstrated home visiting outcomes across 92 studies that met certain criteria for inclusion. The team summarized outcomes across the eight HomVEE outcome domains.
For cost of home visiting outcomes (Modules 2, 3, and 4), the study team conducted a literature scan identifying 24 home visiting studies that included a return on investment or cost analysis. A second scan located 20 non-home visiting studies that monetized similar outcomes. The team extracted and summarized cost data and data sources for each study.
McCombs-Thornton, K., Park, C., Higman, S., Kelley, A., & Cachat, P. (2020). Planning for a pay for outcomes approach in home visiting: A review of research to inform Maternal, Infant, and Early Childhood Home Visiting outcome selection, projected savings, and pricing (OPRE Report No. 2020-90). Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
- Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program:
- Administered by the Health Resources and Services Administration in partnership with the Administration for Children and Families, the MIECHV Program was established in 2010 to support voluntary, evidence-based home visiting for at-risk pregnant women and parents with children up to kindergarten entry. The program provides grants to states, US territories, and tribes, which conduct needs assessments to identify eligible at-risk communities and serve priority populations.
- Home Visiting Evidence of Effectiveness (HomVEE) review:
- Funded by the U.S. Department of Health and Human Services to assess the quality of the research evidence for home visiting models using a standard review protocol. The review is conducted on an annual basis to ensure newer studies are included in the assessment.