Resources to Results

The Washington State

Pay for Success Symposium

November 18, 2015

#pfswa

Host Committee

Resources to Results

The Washington State

Pay for Success Symposium

November 18, 2015

#pfswa

Keynote

David Wilkinson Director

White House Office of

Social Innovation & Civic Participation

Life Cycle of Pay for Success

Moderator Caroline Whistler, Co-President and Co-Founder, Third Sector Capital Partners

Panel

§  Louis Chicoine, Exec. Dir., Abode Services §  Brenda Van Gorder, Dir. of Title 1 Preschool

Program, Granite School District, Salt Lake City §  Fraser Nelson, Dir. of Data and Innovation, Salt

Lake County §  Greta Hansen, Lead Deputy County Counsel,

County of Santa Clara

©  2015,  Third  Sector  Capital  Partners,  Inc.   6

Target Population

•  150-200 costliest chronically homeless individuals – 112 total housing units

Intervention •  Delivered by Abode Services •  Permanent supportive housing: Housing

First plus Modified Assertive Community Treatment

Funders & Grantors

•  The Reinvestment Fund; CSH; The Sobrato Family Foundation; The Health Trust; The California Endowment; The James Irvine Foundation; Google.org; Laura & John Arnold Foundation (Evaluation Grantor)

•  Palantir Technologies (Technology Partner)

Goal •  Improve health and wellbeing of chronically

homeless individuals while reducing costs

Capital Structure •  $6.9 million in upfront financing from

commercial and philanthropic funders

Project Budget

•  $24M: $8M in possible success payments plus $17M in County-funded housing and mental health services

Success Payments Based on number of months of stable tenancy: •  Lease plus verified tenancy in unit •  Minimal time in jail or shelters

Project Overview Project Success Payments

Evaluation Evaluator: UCSF School of Medicine (M. Kushel and M. Raven) Evaluation Design: Randomized controlled trial to assess efficacy of project in reducing costs and improving wellbeing of target population (not tied to success payments)

Project Welcome Home

©  2015,  Third  Sector  Capital  Partners,  Inc.   7

Target  Population

•  250+ severely mentally ill adults who are frequent users of the County’s emergency and inpatient psychiatric facilities

Intervention

•  Delivered by Telecare Corporation •  Intensive Assertive Community Treatment •  Housing support

Timing •  6 year project

Based on cost savings achieved by reducing County expenditures on: •  Purchasing beds from non-County inpatient

psychiatric hospitals •  Reduced/optimized utilization of emergency

and inpatient psychiatric facilities

Success  Payments •  Avoided utilization of emergency and

inpatient psychiatric services for clients enrolled in the program

Unique Characteristics

•  First Mental Health PFS project

Project Overview Project Success Payments

Project  Budget

Goal

•  Improve health and wellbeing of severely mentally ill individuals while reducing costs

Evaluation Evaluator: Stanford School of Medicine Dept. of Psychiatry (K. Humphreys) Evaluation Design: Randomized controlled trial to assess efficacy of project in reducing costs and improving wellbeing of target population

Acute Mental Health Needs PFS Initiative

Utah High Quality Preschool Program

Project  Overview  

§  Financing  to  expand  access  to  high  quality  preschool  to  district’s  most  impacted  children  to  improve  school  readiness  and  long  term  academic  performance    

Popula@on  Served  

§  5  cohorts  of  3-­‐  and  4-­‐year  old  children  who  are  low  income  and  have  other  iden@fied  risk  factors.  

§  6  programs  involved:  2  Public  School  Districts,  1  Charter  School,  1  non-­‐profit  and  2  for-­‐profit  child  cares    

Success  Indicator(s)  

§  Payment  trigger  –  special  educa@on  assignment  §  Other  successes  measured:  school  readiness,  proficiency  on  statewide  

assessments,  other  longitudinal  data    

Ini@al  Investment  

$7  million    

Investors   Goldman  Sachs;  J.B.  Pritzker    

Salt Lake County

Project  Overview  

§  A  porYolio  approach  to  address  three  cri@cal  issues  related  to  the  county’s  priority  of  criminal  and  social  jus@ce  reform:  Recidivism,  homelessness,  maternal  and  child  health  

Popula@on  Served  

§  Individuals  at  high  risk  of  recidivism  §  Persistently  homeless  individuals  §  Low  income  mothers  and  infants  

Success  Indicator(s)  

§  Reduc@on  in  recidivism/use  of  jail  beds;  stable  housing;  maternal/child  health;  income  

Ini@al  Investment  

§  Development  fund  of  $1.2M;  have  not  begun  raise  fund  for  projects  

Investors   §  CRA  banks,  philanthropy,  NFF  grant,  loans  

Project Welcome Home

Project Overview

§  Permanent supportive housing for 150-200 of the costliest chronically homeless individuals in Santa Clara County, CA using 112 units/year

Population Served

§  Chronically homeless individuals who are the most “frequent users” of county services

Success Indicator(s)

§  Increased months of stable tenancy in permanent supportive housing

§  Improved health §  The well-being of acutely chronically homeless individuals

Initial Investment

§  $6.9 million

Investors

§  The Reinvestment Fund, Corporation for Supportive Housing, Sobrato Family Foundation, California Endowment, Health Trust, James Irvine Foundation, Laura and John Arnold Foundation, Google.org, Abode Services

Serves  4,400+  adults  and  children  each  year  

Strong  fiscal  and  management  infrastructure  

Proven  ability  to  lead  large,  mul@-­‐agency  collabora@ons  

Ongoing  commitment  to  evidence-­‐based  prac@ces  and  measurable  impact  

$29  million  agency  

Overview of Abode Services

Housing  First  Model  

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•  Housing  First  -­‐  Proven,  effec@ve,  cost-­‐saving  approach  for  people  experiencing  chronic  homelessness.  

Building Systems through Pay for Success

David Willis Director

Division of Home Visiting and Early Childhood Systems, Health Resources and Services

Administration

U.S. Dept. of Health and Human Services

Emerging Opportunities

Moderator Megan Golden, Dir. of Pay for Success Financing, Institute for Child Success

Panel

§  David Willis, Dir. of Division of Home Visiting and Early Childhood Systems, Health Resources and Services Administration, US Dept. of Health and Human Services

§  Nathan Johnson, Chief Policy Officer, Washington State Health Care Authority (Project Representative)

HVSA and Pay for Success

Feasibility Study •  Will determine if Pay for Success

funding model can significantly expand, strengthen and sustain proven home visiting programs statewide

By spring 2016, study will tell us: •  How we can strengthen and continue to build our entire

home visiting system. •  If the Pay for Success model could be a good fit to support

Washington state’s home visiting work. If yes, our state will then need to decide if we should use it.

• Created  by  state  Legislature  in  December  2010.  Brings  together  state,  federal  and  private  dollars  to  support  a  porYolio  of  high-­‐quality  proven  and  promising  home  visi@ng  programs  –  and  make  sure  they  deliver  results.  

About  

• More  than  2,000  children  and  their  families  in  some  of  our  state’s  most  vulnerable  communi@es  have  access  to  these  programs.    

Popula@on  Served  

• Voluntary,  early  and  proven  interven@on    • Pairs  professionals  with  expec@ng  and  new  families  to  work  together  on  a  regular  basis  in  the  home    

• Strengthens  families  and  gives  children  best  start  possible:  Improve  maternal/child  health,  family  bonds  and  self-­‐sufficiency,  and  school  readiness.    

Why  A  Strong  Investment  

• $11.6M  Current  Budget  

Home Visiting Services Account

The Health Care Authority’s PFS Feasibility Study

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•  Houses 75 homeless individuals w/ chronic alcohol addiction

•  Low-barrier; harm reduction; housing-first

•  Journal of the American Medical Association:

•  Average health and social services cost savings of 53 percent per resident

•  Saved taxpayers over $4 million in first year of operation

Success Story: 1811 Eastlake (DESC)

*hlp://www.desc.org/documents/DESC_1811_JAMA_info.pdf    Better Health, Better Care, Lower Costs  

The HCA PFS model

Better Health, Better Care, Lower Costs  

•  Scope is critical –  PFS is an opportunity to support effective,

innovative services for specific, high-needs populations

•  Communication is key – Because PFS is a relatively new concept, it is

easily misunderstood

•  Now is the Opportunity – Community support is strong and

policymaker support is growing

Key lessons learned so far

Better Health, Better Care, Lower Costs  

Join the Healthier Washington Feedback

Network: healthierwa@hca.wa.gov

Learn more:

www.hca.wa.gov/hw

Better Health, Better Care, Lower Costs  

Role of Funders & Investors

Moderator Ian Galloway, Senior Research Associate, Federal Reserve Bank of San Francisco

Panel

§  Annelise Grimm, Program Officer, The James Irvine Foundation

§  Deborah Kasemeyer, Senior Vice President, Northern Trust

§  Andrea Phillips, Vice President, Goldman Sachs Urban Investment Group