Organization: Public Consulting Group, Inc. Address: 148 State Street, Boston, MA 02109

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1 Name of Respondent: Public Consulting Group, Inc. (PCG) Affiliation: Service Provider, Intermediary Organization: Public Consulting Group, Inc. Address: 148 State Street, Boston, MA Telephone: (617) (Heather Green) A. Please Describe Yourself and Explain Your Interest in This RFI Public Consulting Group (PCG) provides industry-leading management consulting and technology to help public sector education, health, human services, and other government clients achieve their performance goals and better serve populations in need. Founded in 1986 and headquartered in Boston, Massachusetts, Public Consulting Group (PCG) has more than 1,100 professionals in 44 offices around the U.S., in Canada, and in Europe who are dedicated to delivering leading consulting approaches and technologies to public sector clients. PCG and its participant-directed services practice area Public Partnerships, LLC (PPL) support DCF s pursuit of outcomes-based payments for services that reach children and families affected by child abuse. PCG serves as the independent validator of the Massachusetts Pay for Success project aiming to reduce recidivism amongst high-risk youth. Our consultants are very familiar with the Social Impact Bond model and appreciate its potential to produce valuable evidence for the effectiveness of individual providers service models and to infuse the social sector with private resources. This is certainly an exciting model that has generated a lot of interest in both the public and private sector, as DCF is aware. It is also a model that comes with a substantial administrative requirement on the part of the public agency involved. The technical assistance DCF has accepted will offset the demands on the agency, but DCF should be aware 1

2 that these projects require an immense amount of commitment from all parties involved, as PCG has seen firsthand in Massachusetts. The rewards of a Social Impact Bond structure can be great for the investor, for those interested in what works, and for the public but in the short term it would be unrealistic to implement more than one or two of these projects in any one agency. DCF s RFI asks for information about alternative models that could achieve the same desired outcomesbased payments as a classic Social Impact Bond arrangement. We believe that participant-directed services could fit a pay for success structure and may not even require a separate, private funding source. Participant-directed services, a rapidly growing field in which consumers (i.e. clients/families/program participants), under the guidance of a case manager, are empowered to hire staff and procure the services that they most need, is an alternative model that can be structured with performance-based payments to serve children and families affected by substance abuse. PPL is the national leader in participant-directed services. In this service model, participants are given a budget for goods and services. The funds can come from state appropriations, grant awards, waivers, or reimbursements. Individuals and families work with case managers or peer specialists to identify the goods and services that would best support their particular needs. Once the program is operational, the participants are responsible for adhering to their budgets, giving them an opportunity to develop practical skills while giving them a sense of empowerment over their treatment. The participant-directed model has been shown to reduce public costs. Programs allowing participants to use budget-based self-direction models have consistently shown reduced spending when compared to feefor-service models. Individuals and families are not only empowered; they make cost-effective decisions for their own service delivery. 2

3 B. General Areas for Response 1. Please describe the range of interventions (social service programs) that could target improved social outcomes for children and families involved in the child welfare system who are also impacted by substance abuse. 1.1 What evidence-based interventions currently exist that have demonstrated success? Do these interventions have the potential to be implemented more broadly through a social impact bond? Participant direction is an evidence-informed service delivery model that has been shown to facilitate the delivery of needed services, give families the freedom to choose and manage their own providers, increase customer satisfaction, and reduce program costs. PPL provides financial and administrative transaction services that enable consumers to manage budgets. These services include: Payroll and claims payment Banking and disbursing funds Authorization management via a business rules engine Web-based systems with PPL portals E-timesheets, claims, and payments Online and paper reporting of budgets and spending Provider credentialing and network development Criminal background checks Satisfaction surveys Establishment of performance outcome standards. PPL s supports extend to the consumers receiving services, enabling them to be successful. Consumer support services may include: Supports brokers, resource consultants, and personal agent services 3

4 Telephone customer service in English and Spanish with language line available Practical skills training and problem-solving for participants and their service providers. PPL is also IRS-approved to provide fiscal employer agent services, which enable consumers to be employers. These services include: Payroll and timesheets Tax filing and reporting Workers compensation. Participant-directed services have demonstrated myriad successes in the various populations served. For example, compared to counterparts receiving traditional behavioral and mental health services, individuals in participant-directed behavioral and mental health programs were: Less likely to be re-hospitalized More likely to use early intervention services More likely to be working More likely to be in school More likely to be satisfied with their services. Though not evidence-based because no independent evaluation has yet been performed, this is a service model that has been demonstrated effective and desirable in the field. PCG and PPL welcome this opportunity to demonstrate the efficacy of the model through a Pay for Success evaluation. Participant-directed service delivery absolutely could work with a social impact bond structure. PCG expects that the terms of any outcomes-based payments would be an early part of the project s development. We would be willing to consider direct outcomes-based payments tied to enrollments or customer satisfaction or tiered payment rates from public, private, or blended sources. 4

5 1.2 Are there innovative interventions that may lack a strong evidence base (for example, due to nascent program models or models that are currently undergoing evaluations) but that may be appropriate for incorporation in the program due to potential for high net benefits? Describe the intervention(s) in detail, including the target population, program goals, existing evidence of success, and current implementation strategies. Participant-directed services is a growing and proven system of service administration and delivery, but it has not yet been tested in the field of children and families affected by substance abuse. PPL has a wide range of experience with this service model all across the country for diverse participant types, including families affected by autism, the elderly, and mental and behavioral health service consumers. We expect that DCF would see outcomes similar to those in other markets, namely increased client satisfaction and lower costs. In addition to the cost-conscious expenditure patterns of participants, PCG expects that DCF could see lower costs resulting from reduced child removal episodes and congregate care utilization, reduced utilization of expensive in-patient therapies, and reduced hospitalizations. An important part of a participant-directed services pay for success project would be the identification of the target population and randomization plan for treatment. PCG understands that there are referrals to the state s IDEA Part C Birth to Three System for families with young children involved in substantiated abuse or neglect cases. These and other similarly severe cases where a child s well-being is at high risk would not be appropriate for the proposed service model. PCG envisions a partnership with Connecticut s Project SAFE, the Recovery Specialist Voluntary Program, and the state s Recovery Case Management services to be developed as this project takes shape wherein PCG would develop a concise set of standards for eligible families and our partners would provide referrals of cases that meet those criteria for possible enrollment in participant direction. 5

6 1.3 Describe the social outcomes that the intervention(s) target. What level of impact can be expected from the intervention(s)? The social outcomes targeted by the participant-directed service model would be those of DCF s own overarching goals for children to be healthy, safe, and strong. There are also administrative outcomes that DCF could expect to realize through the implementation of the participant-directed model. Participant-directed services are inherently family-centered and would promote a family-centered practice within the agency. By its nature participant direction fosters linkages among community collaboratives and service providers because all are incentivized to register with the third-party administrator and make themselves available to participants. And finally, it would expand DCF s use of an evidence-informed practice in a promising new area. As children and families affected by substance abuse would be a new market for participant-directed services, PCG cannot provide a quantified expectation of impact from the implementation of the service model at this time. 1.4 Describe the type and amount of any governmental savings that could be achieved as a result of implementing the program outlined above. As described above, in addition to the cost-conscious expenditure patterns of participants, PCG expects that DCF would see lower costs resulting from reduced utilization of expensive in-patient therapies, reduced child removal episodes and congregate care utilization, and reduced hospital visits and hospitalizations. 6

7 1.5 Describe potential outcome(s) that could be measured and used to evaluate the success of the interventions, along with a process for collecting the required data. Outcome measures aligned with DCF s primary goal of supporting children to be healthy, safe, and strong could include: Healthy Reduced inpatient treatment enrollment, reduced hospital visits and admissions Safe Increased safety at home (reduced experiences of neglect, reduced congregate care enrollments, reduced contact with the criminal justice system) Strong Increased connection to protective and supportive resources in the community (increased awareness of and use of local resources) 1.6 Describe potential evaluation strategies. Because it relies on self-directed choices, participant direction can be especially effective if participants are allowed to self-select. In order to avoid creaming the treatment population, PCG envisions a quasiexperimental design in which DCF s six regions are paired according to demographic similarities and then one from each pair randomly assigned to the treatment or comparison group. Families served in the treatment group regions would be offered the option of enrolling in participant direction, and their outcomes would be measured against those in their paired comparison group region. The independent evaluator would be responsible for conducting the randomization and tracking the outcomes of the enrollees against those of the comparison group. PCG is also willing to consider evaluation design recommendations from the state s TA advisor and the independent evaluator eventually selected for the project. From our work as the independent validator of the evaluator on the Massachusetts Pay for Success project, we are deeply familiar with the statistical intricacies of the evaluation design of a SIB project now getting off the ground and could contribute to design discussions as those take shape. 7

8 2. Please describe current service provider capacity to engage in this model, and what can be done to improve this capacity. In particular please address the following points: 2.1 What are the barriers that service providers face in becoming ready for implementation of a pay for success delivery model? The participant-directed model does not present barriers to implementation for PPL. There would be time and resources required to establish the administrative structure and the menu of approved services as part of the project s establishment. Once in place, PPL s third-party administration of participant-directed accounts facilitates the delivery of services needed most by each consumer. PPL currently has the capacity to launch this project and is ready for implementation of a pay for success delivery model, pending agreement upon the performance-basis terms. Providers registered as part of the menu of available services available for participant selection sometimes require some training regarding how the administrative structure works. PPL is able and ready to provide that training if needed, as discussed in 2.2 below. 2.2 What technical assistance and support would service providers need to become ready to participate in a pay for success service delivery model? As the national leader in participant-directed services in a wide range of markets including services for children with autism, elderly, and behavioral and mental health services, PPL has an established approach for informing stakeholders about the participant-directed model and how it can benefit them. Generally, a participant direction model allows participants to access goods and services within an existing market. PPL can provide training to service providers on participant direction and the program as appropriate, but often this is not necessary because the providers see the participants as just another purchaser of their service in 8

9 the market. PPL also works with the participant individuals and families so that they can make the best decisions for their service needs. 3. Please describe a potential governance structure for the program. In particular, please address the following: 3.1 Describe the use of intermediaries and/or other advisors, service providers, investors, and evaluators, and the process for selecting and establishing relationships between DCF and each of these types of entities. Explain the role that each entity would play during the development and implementation of the program. The funding for a project to establish participant direction for the target population could come from grant or waiver funds, a private investor, or DCF could choose to allocate some of the funds it already spends on services to children and families affected by substance abuse. If a private investor is involved, PCG expects that an intermediary would be involved to help arrange the contracts and terms of evaluation. PCG would be able and willing to serve as the intermediary, potentially expediting the process as we are most familiar with the contracting options for PPL s services. PCG s participant-directed services practice area PPL would serve as the third-party administrator of participant accounts. This administration of funds would constitute the services in this project. In order for the PPL service model to work, it must interact with the case managers and service providers in place to support the target population. The services that ultimately reach the children and families affected by substance abuse would include the universe of services currently available and approved for selection by DCF. PCG would work with DCF and the SIBLAB fellow to establish connections between the appropriate parties. PCG expects an independent evaluator would be identified either by DCF s SIBLAB fellow or by the intermediary if a separate one is involved. PCG would work cooperatively with the evaluator to set the terms and expectations around outcomes measurement. 9

10 There are several possibilities for a governance structure here, depending especially on whether private funders are involved. Please see the following graphic for an overall idea of the envisioned governing structure. If there is a private funder involved, the flow of funds would begin there; if DCF is interested in establishing a performance-based payment structure with PPL, that could potentially work as well. We expect the SIBLAB fellow will be responsible for contract establishment between the relevant parties and help with identification of the evaluator. From our work in Massachusetts we are aware that the reporting demands of a project like this are rigorous and are prepared to cooperate readily so that all interested stakeholders have the information they need. 10

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12 3.2 Are there alternative models that DCF should consider, including contracting directly with service providers? The information provided here describes what PCG believes to be a worthwhile alternative model, participant-directed services for children and families affected by substance abuse. This is a model that would enable DCF to serve its target population with a proven-effective, cost-effective, and desirable model that puts the people served in control of their own services. C. Other Suggestions None at this time. 12