Governor’s Commission on Innovation, Efficiency, and Transparency October 25, 2013 The Pew-MacArthur Results First Initiative: Investing in Programs that.

Slides:



Advertisements
Similar presentations
DC Responses Received WA OR ID MT WY CA NV UT CO AZ NM AK HI TX ND SD NE KS OK MN IA MO AR LA WI IL MI IN OH KY TN MS AL GA FL SC NC VA WV PA NY VT NH.
Advertisements

National Core Indicators Overview for the State of Washington Lisa A. Weber, Ph.D. Division of Developmental Disabilities.
Reforming State Long-Term Care Services and Supports Through Participant Direction NASHP State Health Policy Conference October 2010 Suzanne Crisp Director.
The Pew-MacArthur Results First Initiative: INVESTING IN PROGRAMS THAT WORK May 15, 2014 Sara Dube, Manager Ashleigh Holand, Manager-State Policy.
Results First Using Cost-Benefit Analysis to Analyze State Policy August 6, 2012.
The Research Behind Strengthening Families. Implementation w/ Fidelity Implementation w/ Fidelity Results Model Tested by RCT Model Tested by RCT Traditional.
Supporting College Success for Students from Foster Care Recognizing Advocacy, Practice and Policy Advances! May 10,
National Journal Presentation Credits Producers: Katharine Conlon Director: Afzal Bari House Committee Maps Updated: March 19, 2015.
Safety Up, Costs Down: Putting Results First Ben Fulton, Associate, The Pew-MacArthur Results First Initiative Amalia Mejia, Program Coordinator, California.
State and Local Health Department Governance Classification System
The Policy Challenge While we talk about making strategic choices, the budget process relies on inertia and anecdote Very limited data on: What programs.
The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid.
Medicaid Eligibility for Working Parents by Income, January 2013
WA OR ID MT ND WY NV 23% CA UT AZ NM 28% KS NE MN MO WI TX 31% IA IL
House price index for AK
The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid.
WY WI WV WA VA VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
WY WI WV WA VA VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
Children's Eligibility for Medicaid/CHIP by Income, January 2013
The State of the States Cindy Mann Center for Children and Families
Non-Citizen Population, by State, 2011
Status of State Medicaid Expansion Decisions
Share of Women Ages 18 – 64 Who Are Uninsured, by State,
Executive Activity on the Medicaid Expansion Decision, May 9, 2013
Percent Change in Average Nongroup Premium Following Implementation of a State Individual Mandate, 2019 WA –15.1% NH: –13.7% ME –10.7% MT –11.1% ND –15.4%
WY WI WV WA VA VT UT TX TN1 SD SC RI PA1 OR OK OH ND NC NY NM NJ NH2
WY WI WV WA VA VT UT TX TN1 SD SC RI PA OR OK OH1 ND NC NY NM NJ NH NV
WY WI WV WA VA* VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
WY WI WV WA VA VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
WA –16.9% NH: –18.8% ME –14.1% MT –23.7% ND –22.0% VT: –12.6% OR
Mobility Update and Discussion as of March 25, 2008
Current Status of the Medicaid Expansion Decision, as of May 30, 2013
IAH CONVERSION: ELIGIBLE BENEFICIARIES BY STATE
State Health Insurance Marketplace Types, 2015
State Health Insurance Marketplace Types, 2018
HHGM CASE WEIGHTS Early/Late Mix (Weighted Average)
Status of State Medicaid Expansion Decisions
The Pew-MacArthur Results First Initiative: Improving Outcomes Through Evidence-Based Policymaking August 4, 2014.
Status of State Participation in Medicaid Expansion, as of March 2014
Percent of Women Ages 19 to 64 Uninsured by State,
Status of State Medicaid Expansion Decisions
10% of nonelderly uninsured 26% of nonelderly uninsured
22% of nonelderly uninsured 10% of nonelderly uninsured
State Health Insurance Marketplace Types, 2017
S Co-Sponsors by State – May 23, 2014
The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid.
WY WI WV WA VA VT UT* TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
Seventeen States Had Higher Uninsured Rates Than the National Average in 2013; Of Those, 11 Have Yet to Expand Eligibility for Medicaid AK NH WA VT ME.
Employer Premiums as Percentage of Median Household Income for Under-65 Population, 2003 and percent of under-65 population live where premiums.
Employer Premiums as Percentage of Median Household Income for Under-65 Population, 2003 and percent of under-65 population live where premiums.
Average annual growth rate
Market Share of Two Largest Health Plans, by State, 2006
Percent of Children Ages 0–17 Uninsured by State
Executive Activity on the Medicaid Expansion Decision, May 9, 2013
Current Status of State Medicaid Expansion Decisions
How State Policies Limiting Abortion Coverage Changed Over Time
United States: age distribution family households and family size
Status of State Medicaid Expansion Decisions
Employer Premiums as Percentage of Median Household Income for Under-65 Population, 2003 and percent of under-65 population live where premiums.
Percent of Adults Ages 18–64 Uninsured by State
Uninsured Nonelderly Adult Rate Has Increased from Percent to 20
Status of State Medicaid Expansion Decisions
10% of nonelderly uninsured 26% of nonelderly uninsured
WY WI WV WA VA VT UT* TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
Ashleigh Holand, Manager-State Policy
WY WI WV WA VA VT UT* TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
Current Status of State Individual Marketplace and Medicaid Expansion Decisions, as of September 30, 2013 WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK.
Status of State Medicaid Expansion Decisions
WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV
22% of nonelderly uninsured 10% of nonelderly uninsured
Presentation transcript:

Governor’s Commission on Innovation, Efficiency, and Transparency October 25, 2013 The Pew-MacArthur Results First Initiative: Investing in Programs that Work

1 The Policy Challenge While we talk about making strategic choices, the budget process relies on inertia and anecdote Very limited data on: –What programs are funded –What each costs –What programs accomplish –How they compare

2 The Solution: Bring Evidence Into the Process Target funds using rigorous evidence Stop funding ineffective programs Ensure programs are implemented effectively Achieve dramatic improvements without increased spending

3 The cost-benefit analysis approach Long-standing approach to policy analysis Widely used in the private sector Increasingly used by states Goal: Assess whether a program generates enough benefits to justify funding

4 States are increasing use of CBA Report found number of studies done by states is growing significantly each year States are increasingly mandating that studies be done States are using results in policy and budget processes

5 Predict program impacts in your state Calculate and compare long- term costs and benefits Use the best national research to identify what works

6 Step 1: Conduct a Program Inventory Identify the programs currently provided in New Hampshire and the population that is served by those programs Identify the current funding for programs Assess whether the programs are evidence-based Determine if programs are being implemented according to design

7 Step 1: Inventory Programs *Washington State 2012 dollars POLICY/PROGRAMCOST LONG-TERM BENEFITS COST/BENEFIT RATIO Intensive supervision (only)$4,140-$578-$0.14 Mental health court$2,935$20,424$6.96 Community drug treatment$1,602$17,711$11.05 Correctional education in prison$1,128 $21,426$19.00 Work release $661$7,117$10.77 Cognitive behavioral therapy $412$9,695$23.55 Community job training & aid$135$5,501$40.76 JUVENILE PROGRAMS Functional Family Therapy$3,262$70,370$21.57 Aggression replacement training$1,508 $62,947 $41.75 Coordination of services $395 $5,501$13.94 Scared Straight $65 -$4,949-$76.35

8 Step 2: Identify Program Costs Identify the costs of serving persons in each program Include direct and indirect costs Calculate marginal costs for each program

9 Step 2: Identify Costs *Washington State 2012 dollars POLICY/PROGRAMCOST LONG-TERM BENEFITS COST/BENEFIT RATIO Intensive supervision (only)$4,140-$578-$0.14 Mental health court$2,935$20,424$6.96 Community drug treatment$1,602$17,711$11.05 Correctional education in prison$1,128 $21,426$19.00 Work release $661$7,117$10.77 Cognitive behavioral therapy $412$9,695$23.55 Community job training & aid$135$5,501$40.76 JUVENILE PROGRAMS Functional Family Therapy$3,262$70,370$21.57 Aggression replacement training$1,508 $62,947 $41.75 Coordination of services $395 $5,501$13.94 Scared Straight $65 -$4,949-$76.35

10 Step 3: Predict and Monetize Outcomes –Costs per felony conviction –Convictions avoided per participant –Other benefits throughout system –Victimizations avoided per participant Taxpayer benefits (avoided costs) Victimization benefits (avoided costs)

11 Taxpayer outcomes –Avoided cost of delivery of services and programs Societal outcomes –Avoided costs incurred of crime victims –Tangible costs (e.g., lost wages, health care) –Intangible costs (e.g., pain and suffering) –Estimates based on medical records, insurance claims, and court judgments Assess full program outcomes

12 Meta-analysis of Functional Family Therapy Follow-up Years Source: Washington State Institute for Public Policy Recidivism Rate Without FFT (actual baseline) RECIDIVISM RATES REDUCED BY 22% With FFT

13 Cost-Benefit of Functional Family Therapy BENEFITS PER FAMILY WA STATE 2010 DOLLARS MAIN SOURCE OF BENEFITS Reduced crime $31,745 Lower state & victim costs Increased high school graduation $5,686 Increased earnings Reduced health care costs $307 Lower public costs Total Benefits Per Family $37,739 Cost Per Family $3,190 Net Present Value $34,549 Benefits Per Dollar of Cost $11.86

14 Cost-benefit of Nurse Family Partnership BENEFITS PER FAMILY WA STATE 2010 DOLLARS MAIN SOURCE OF BENEFITS Reduced crime & abuse $6,611 Lower state & victim costs Educational gains $17,770 Increased earnings Reduced public assistance costs $5,944 Lower public costs Total Benefits Per Family $30,325 Cost Per Family $9,421 Net Present Value $20,904 Benefits Per Dollar of Cost $3.23

15 Step 4: Compare Costs and Benefits Across Program Portfolio *Washington State 2012 dollars POLICY/PROGRAMCOST LONG-TERM BENEFITS COST/BENEFIT RATIO Intensive supervision (only)$4,140-$578-$0.14 Mental health court$2,935$20,424$6.96 Community drug treatment$1,602$17,711$11.05 Correctional education in prison$1,128 $21,426$19.00 Work release $661$7,117$10.77 Cognitive behavioral therapy $412$9,695$23.55 Community job training & aid$135$5,501$40.76 JUVENILE PROGRAMS Functional Family Therapy$3,262$70,370$21.57 Aggression replacement training$1,508 $62,947 $41.75 Coordination of services $395 $5,501$13.94 Scared Straight $65 -$4,949-$76.35

16 Results First Work in States

17 Washington State’s Long-term Success 15+ years of using approach to help steer budget decisions Have achieved better outcomes at lower costs LOWERED CRIME RATE and achieved $2.7 BILLION in higher long-term benefits

18 Juvenile Crime Reduction Benefits Change since 1990 in the U.S. and Washington State Washington State 67% lower United States 49% lower In 2003, Washington begins “full fidelity” implementation In 2000, Washington begins evidence-based Juvenile Justice program Source: Washington State Institute for Public Policy

19 Participation in Results First VT NH MA RI CT NJ DE MD AK HIWATN MT OR ID WY CO UT NV CA AZ NM NE KS OK TX ME ND SD MN LA AR MO IA WI MI IL IN OH PA NY WV KY MS AL GA SC NC FL VA AK

20 What are Results First states doing? enacted legislation incorporating Results First into their policy making process used models to analyze legislation, avoiding millions in potential costs

21 New Mexico Legislative Finance Committee leads initiative, expanding into agencies Implemented Results First in all available policy areas Innovative “Cost of Doing Nothing” report found $360M in recidivism-related corrections costs over next 15 years Used Results First model to target $17M for evidence-based programming in early education and criminal justice

22 Iowa Housed in the Departments of Corrections and Human Rights Found state’s domestic violence treatment program was ineffective –Replacing with new program to achieve higher ROI Used model to analyze sentencing reform proposals

23 New York Used model to develop Governor’s public safety budget –Referenced in 2013 State of the State Address Restructuring $11.4M in Alternatives to Incarceration funds to prioritize cost-effective programs –$5M allocated through competitive grant process incorporating cost-benefit analyses

24 Mississippi Legislative PEER Committee implementing model Very strong legislative leadership support Using approach to re-energize performance budgeting system Currently assessing criminal justice and education programs

25 Vermont Legislative Joint Fiscal Office began initiative –Legislatively established the Criminal Justice Consensus Cost- Benefit Working Group to expand the Vermont Results First model Used analysis to cut funding to inefficient correctional education program

26 Results First can be used to analyze many policy areas Criminal JusticeK-12 EducationEarly EducationChild WelfareSubstance AbuseMental Health Prevention Programs

27 What does it take to become a Results First state?

28 Commitment to evidence-based decision making Ability to provide necessary data Willingness to dedicate resources State Selection Criteria 1 2 3

29 The Role of Partner States Secure leadership support Appoint a policy work group Establish a staff work group with project manager Collaborate with Results First to strengthen the model and build a learning community of states

30 Services provided by Results First Provide software Train staff in the approach Provide ongoing technical assistance Help interpret results for policymakers Compile and share lessons learned with other participating states Expand and update model No charge for Results First services

31 Goal – Dramatically improve outcomes by: –Fund programs that are proven to work (and cut those that don’t) –Programs must be properly implemented –Must target the right people –Compare outcomes to predictions –Require new programs to prove success Using Evidence Ensuring Program Quality Tracking Results

32 This approach should drive the system Appropriations (investment advice) Research (test new programs) Implementation (ensure fidelity) Oversight (monitor outcomes)

Contact: Gary VanLandingham Director