The following article was published in the April 2019 issue of the American Public Human Services Association’s Policy & Practice Magazine.
King County, Washington, wanted a game changer.
For years, the county’s health and human services contracting had followed a familiar pattern: most government-funded services were focused on crisis intervention rather than prevention. Funding generally went to larger providers rather than smaller community-based organizations that typically served the county’s historically underrepresented residents. And in many cases, the county lacked data on which services worked best for residents.
“We just weren’t achieving the kinds of outcomes we wanted for children in our community,” said Carrie S. Cihak, King County’s Chief of Policy.
In 2014, the county reinvented its approach. It started with a broad community engagement strategy that included events like “community cafés,” surveys, and interviews with residents and providers to build alignment around shared goals. “We started with the outcomes we wanted to achieve for children and youth in the county: babies being born healthy, the journey to adulthood being healthy and safe, and building a supportive environment in our community around kids,” Cihak said.
When county voters in 2015 passed the Best Starts for Kids initiative — which generates an average of $65 million a year to help achieve these outcomes — County Executive Dow Constantine and his team had already laid the foundations for a new contracting system. It would focus on increasing equity, strengthening partnerships with community-based providers, and gathering rigorous evidence of impact to track whether the county was making progress toward key goals
The What Works Toolkit
King County is part of a growing movement of local and state governments that are shaking up decades-old procurement practices, shifting away from a compliance-focused model toward new approaches that incentivize innovation, increase collaboration with providers, and build the capacity of human services leaders to measure outcomes and steer public investments toward the most effective approaches.
With the support of the Kresge Foundation, Results for America gathered examples of how cities, counties, and states across the country have accelerated their governments’ push toward outcomes-focused contracting. We bundled these ideas together into the “What Works Toolkit,” a framework for understanding the policies and practices necessary to move state and local government agencies and human services providers from compliance-focused to outcomes-focused contracting.
While the approaches varied, we identified five key recommendations to help human services leaders build a more results-driven culture:
Step 1: Gather Feedback and Focus on Outcomes
As King County learned, the first step toward a more results-driven approach is to engage with human services providers, service recipients, and community groups to gather feedback, define desired results, and establish outcome goals for each contract. A good start is to identify which contracts are approaching a renewal or are central to your local or state government’s priority goals.
Many cities and counties are getting creative about opening new and better channels of communication with service providers and other key stakeholders. In New York City, Mayor Bill de Blasio created the Nonprofit Resiliency Committee, which was comprised of city staff and providers, coalitions, academia, and philanthropies. The Committee was charged with identifying, designing, and promoting solutions to increase collaboration between the city and the nonprofit human services sector. Through the initiative, the city created the Collaborative Guide to Communications with the goal of broadening engagement with nonprofit experts, consistent with the city’s procurement policy for safeguarding open competition.
As the New York City guide illustrates, the best conversations begin well before the issuance of a request for proposal (RFP) for services. By using pre-proposal conferences with providers, letters of interest, or requests for information, government agencies can validate community needs, align expectations, and collaboratively develop outcomes. Many of these tools and templates are included in a new report that Results for America produced with Project Evident, An RFI Guide: How Requests for Information Can Improve Government Human Services Contracting.
Most important, these early discussions help government leaders and service providers develop a shared sense of mission. Some policymakers are taking the next step by building these expectations right into their contracts. For example, Washington, D.C.’s Procurement Practices Reform Act of 2010 requires each city government contract to include performance standards and expected outcomes of the proposed contract.
Step 2: Break Down Government Funding Silos
Even the best efforts by policymakers and providers to shift to a results-driven approach can be undermined by siloed programs and overlapping contracts. But increasingly local and state human services leaders are experimenting with more flexible approaches, including combining funds from multiple sources, streamlining reporting requirements, and forging more holistic solutions to entrenched problems.
For policymakers, the first step is to review existing funding streams and determine whether government agencies can blend funding streams into one solicitation to allow providers to focus on outcome-oriented services rather than record-keeping for multiple grants. When Seattle was seeking better outcomes from its homeless services contracts, the city began by determining which contracts it could consolidate. Through its participation in Bloomberg Philanthropies’ What Works Cities initiative, the city’s Department of Human Services worked with the Government Performance Lab at the Harvard Kennedy School to merge 26 separate contracts into eight portfolio contracts, giving homeless services providers more flexibility to shift funding between programs as needed to try to achieve the city’s overarching goal: helping homeless residents into permanent housing.
When feasible, government agencies can also streamline allowable uses across each contract to minimize the administrative compliance burden on human services providers. Agencies should also provide incentives for multi-year contracts that enable a focus on sustainable, long-term change. When Bernalillo County, New Mexico, was seeking to improve outcomes in behavioral health services, county leaders worked with the Government Performance Lab to issue a new problem-based RFP and used the new contracting process as an opportunity to transform its service delivery system to focus on collaboration, real-time data sharing, evaluation, and program improvement. This procurement approach is now being adopted more broadly throughout county government
Step 3: Issue Clear Requests for Proposals
As government agencies develop their RFPs, they should make sure they include clear outcome goals and performance measures that reflect the input of providers and the broader community. By preferencing programs and practices with evidence of effectiveness – such as those found in evidence-based clearinghouses – human services leaders can help increase the likelihood of achieving those goals.
For example, the Florida Department of Juvenile Justice requires the use of evidence in the RFP process, and then uses real-time data uploaded to its Juvenile Justice Information System to track results – an approach that was featured in Results for America’s Invest in What Works State Standard of Excellence. The Santa Cruz Probation Department, working with the Pew-MacArthur Results First Initiative, has used its RFP process to drive investments toward evidence-based interventions while also collecting the outcomes data needed to help policymakers determine which approaches are most effective.
Simply cutting and pasting the word “evidence-based” into RFPs and contracts is not enough, since evidence can mean anything from an anecdote to the most rigorous randomized controlled trials. Policymakers should start by defining what they mean by “evidence-based,” and they can find good models in the What Works Toolkit, including links to outcomes-focused RFPs and sample contracts that promote proven solutions.
Step 4: Fund Outcomes and Build Evidence
Another way government agencies can ensure they are getting the best results is to pay for them. By connecting the payment of at least part of a contract to the achievement of measurable outcomes — whether through Pay for Success, outcome rate cards or outcome bonus payments — human services leaders can incentivize and reward providers that meet key goals.
In Pennsylvania, the state Department of Corrections uses a carrot-and-stick approach to help human services providers assist newly paroled inmates as they transition back to their communities. Providers whose clients attain a better-than-expected recidivism rate earn an increase of 1% in the Department’s per diem rate, while providers with recidivism rates that are worse than expected for two consecutive contracting periods risk having their contract terminated. Department officials credit this system with an 11.3% reduction in recidivism rates for 2014-2015.
State and local governments can also help providers generate evidence of what works best to address community challenges. King County is setting aside five percent of funding from the Best Starts for Kids initiative for rigorous assessment, data collection, and evaluation, including technical assistance to local nonprofits so they can test innovative solutions and build a base of evidence for new approaches.
“In the past, our award of a grant to a partner organization kind of was the outcome,” King County Executive Dow Constantine explained. “Now we are drilling down and making sure we are focusing on the results we want to see for the people and measuring those results.”
Step 5: Create Feedback Loops
As state and local governments improve their systems for gathering and sharing data, they should harness the power of this new data through regular discussions with providers to determine which strategies work best and which can be improved.
When Rhode Island’s Department of Children, Youth & Families shifted to a results-driven contracting process — structuring services around 15 outcome categories and linking those to specific performance objectives — the agency gave vendors new flexibility to propose the services, supports and resources that achieved the best outcomes for children and families. To institutionalize performance feedback loops, agency leaders added small performance-based payments into all new contracts for family-based and residential services. The agency also increased the sharing of administrative data so that both service providers and agency staff could track what happens with clients after they exit programs.
Using this data, and working with experts from the Government Performance Lab, Rhode Island officials piloted an active contract management system with four providers, which allowed agency staff and providers to monitor outcomes in real-time and quickly intervene if performance starts to drop. The results? The state has reduced the number of children in group care by 32% since 2015 (with help from the Annie E. Casey Foundation and Casey Family Programs), expanded its portfolio of family-base services and supports, and reduced the number of children entering state custody due to the improved performance of preventative services.
Deb Buffi, the agency’s Associate Director of Contracts and Compliance, said some of the best learning has come at the regular meetings where different providers join with agency staff to review the data in a non-threatening atmosphere where all parties can assess what is working, what is not working, and how they can continually improve. “Everyone is willing to come to the table to brainstorm solutions with us and their peers if their monthly data shows a slip in outcomes,” Buffi said. “This is not a ‘gotcha’ environment.”
As the months went by and results kept improving, the providers and agency staff would erupt in applause when the new statewide performance data was shown at meetings. “We’re all jointly excited that kids and families in Rhode Island are the ones to benefit,” Buffi said.
For more on the What Works Toolkit, go to www.results4america.org/what-
Jed Herrmann is Vice President of State and Federal Policy Implementation at Results for America