Notes from the field: how exploring pay for success helped a health clinic strengthen its data systems

In Providence, Rhode Island, thousands of low-income, uninsured residents access primary care and health education services through Clinica Esperanza/Hope Clinic (CEHC), which provides free, culturally and linguistically attuned medical services to patients in the Greater Providence area. Like many small community-based organizations, CEHC constantly works to attract and maintain funding. But it had limited capacity to use data in order to demonstrate the effectiveness of services—key information that can help secure funding.

CEHC engaged the Urban Institute’s (Urban’s) Pay for Success Administrative Data pilot to strengthen its data capacities and systems, identify alternative funding opportunities, and improve tracking and reporting on impact, through an exploration of the pay for success (PFS) model. Over the two-year engagement, staff and volunteers at CEHC and Urban have focused on several priorities:

• Identifying the potential of a PFS project. PFS is an innovative funding model and offers service providers the potential to secure upfront, multi-year funding to expand their programs. Although PFS presents some risks for providers, including a heightened level of scrutiny in the form of a rigorous evaluation, it also presents an opportunity to engage key partners and demonstrate impact. To secure this buy-in, CEHC needed to educate local stakeholders about the value of the PFS model, current PFS projects, and the ways in which CEHC could partner with them to design a PFS project or similar outcomes-based contract. To this end, CEHC and Urban met with stakeholders from local organizations, data stewards and experts, state political leaders, and officials from state agencies to describe pay for success and the work being done.
• Strengthening data capacity and improve data on service population. Working closely with CEHC staff and volunteers, the Urban team recommended ways to enhance CEHC’s existing data collection processes, identified data gaps, and provided recommendations for how to bridge those gaps. This year, CEHC will conduct a door-to-door survey in the communities that CEHC serves, and Urban will advise on survey methodologies and best practices. CEHC plans to use data from the survey to improve outreach and programming and inform its strategy and conversations with local partners.
• Estimating cost-benefit impact of CEHC on the health system. Estimating the cost-benefit of the program and securing outcome payors (those who have a stake in seeing the beneficial outcomes) poses one of the greatest obstacles to potential PFS projects in the health care field. Despite emerging evidence that CEHC’s patients are experiencing health improvements, it is challenging for CEHC to link this impact to the broader health system in Rhode Island, and subsequently demonstrate that CEHC is a cost-effective health investment.

Urban and CEHC are working to estimate CEHC’s system-wide benefits, including the organization’s reduction of costly, preventable emergency department visits, by comparing CEHC patient outcomes with outcomes for a matched comparison group. To do so, both organizations must ensure that CEHC has robust data on its own patients, and then match the dataset with a reasonable comparison from state Medicaid data. CEHC will begin the collect the necessary data in 2019, and an evaluator will analyze the data when they have been matched with Medicaid data.

CEHC has demonstrated its commitment to improving results by gathering, analyzing, and using patient and partner data for performance management. For CEHC, exploring PFS has been about more than just understanding a single funding model: it has presented an opportunity to think about the most effective ways to measure and communicate impact to key partners and to use data to better serve patients.

Lessons for other sites

Urban’s work with CEHC has surfaced several lessons that might be relevant for other service providers interested in PFS:

• Demonstrating costs and savingsof particular interventions in the health sector is a complicated undertaking and requires thorough knowledge of health system funding structures and state context.
• Securing champions in government helps advance a project’s chances and project proponents should make a clear appeal to political priorities, be they public cost savings, addressing emerging or worsening social issues, or serving a population of interest.
• Making improvements to data systems must have broader value (beyond determining PFS feasibility) for the organization and staff asked to make those changes. The data should be useful for strengthening the organizational business case and helping better serve clients.
• Building data capacity, including developing robust data sets and securing partnerships with other data stewards, takes time and patience. Data sharing is an iterative process, built through forging and formalizing trusted relationships. With diligence and alignment of interest, these relationships can bear valuable insights for communities.

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